- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $941.00 / $2,758.00 / $5,432.00
| Facility | | $941.00 | $2,758.00 | $5,432.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,898.80 / $10,379.28 / $14,106.04
| Facility | | $5,898.80 | $10,379.28 | $14,106.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $40.00 / $40.00 / $859.98
| Facility | | $40.00 | $40.00 | $859.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,650.00 / $1,650.00 / $1,650.00
| Facility | | $1,650.00 | $1,650.00 | $1,650.00 |
- 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 |