- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $756.00 / $2,694.00 / $4,767.27
| Facility | | $756.00 | $2,694.00 | $4,767.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,319.33 / $11,197.61 / $19,435.52
| Facility | | $6,319.33 | $11,197.61 | $19,435.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $40.00 / $40.00 / $2,610.23
| Facility | | $40.00 | $40.00 | $2,610.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,350.00 / $1,350.00 / $1,350.00
| Facility | | $1,350.00 | $1,350.00 | $1,350.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,200.00 / $5,780.00 / $13,506.00
| Facility | | $1,200.00 | $5,780.00 | $13,506.00 |