- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $747.71 / $1,850.00 / $4,050.00
| Facility | | $747.71 | $1,850.00 | $4,050.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,685.25 / $9,682.37 / $13,982.44
| Facility | | $5,685.25 | $9,682.37 | $13,982.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $40.00 / $40.00 / $563.88
| Facility | | $40.00 | $40.00 | $563.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,200.00 / $1,200.00 / $1,200.00
| Facility | | $1,200.00 | $1,200.00 | $1,200.00 |
- 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 |