- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $841.00 / $2,447.00 / $5,260.00
| Facility | | $841.00 | $2,447.00 | $5,260.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,898.80 / $11,987.23 / $17,695.54
| Facility | | $5,898.80 | $11,987.23 | $17,695.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $40.00 / $40.00 / $1,148.43
| Facility | | $40.00 | $40.00 | $1,148.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,400.00 / $1,400.00 / $1,400.00
| Facility | | $1,400.00 | $1,400.00 | $1,400.00 |
- 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 |