- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $841.00 / $2,447.00 / $5,687.00
| Facility | | $841.00 | $2,447.00 | $5,687.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,898.80 / $10,406.20 / $14,708.96
| Facility | | $5,898.80 | $10,406.20 | $14,708.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $40.00 / $40.00 / $706.71
| Facility | | $40.00 | $40.00 | $706.71 |
- 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 |