- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $756.00 / $2,397.00 / $4,392.00
| Facility | | $756.00 | $2,397.00 | $4,392.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,114.57 / $8,815.29 / $14,166.86
| Facility | | $5,114.57 | $8,815.29 | $14,166.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $40.00 / $40.00 / $608.09
| Facility | | $40.00 | $40.00 | $608.09 |
- 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 |