- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $593.00 / $1,417.20 / $3,685.00
| Facility | | $593.00 | $1,417.20 | $3,685.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,533.66 / $9,322.27 / $13,354.75
| Facility | | $5,533.66 | $9,322.27 | $13,354.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $40.00 / $40.00 / $597.72
| Facility | | $40.00 | $40.00 | $597.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $725.00 / $725.00 / $725.00
| Facility | | $725.00 | $725.00 | $725.00 |
- 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 |