- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $756.00 / $2,397.00 / $4,061.29
| Facility | | $756.00 | $2,397.00 | $4,061.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,681.72 / $8,437.98 / $11,892.73
| Facility | | $4,681.72 | $8,437.98 | $11,892.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $40.00 / $40.00 / $939.55
| Facility | | $40.00 | $40.00 | $939.55 |
- 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
- $1,141.00 / $4,717.00 / $11,696.00
| Facility | | $1,141.00 | $4,717.00 | $11,696.00 |