- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $756.00 / $2,418.00 / $4,985.75
| Facility | | $756.00 | $2,418.00 | $4,985.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,880.28 / $12,906.32 / $26,164.90
| Facility | | $6,880.28 | $12,906.32 | $26,164.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $40.00 / $40.00 / $712.68
| Facility | | $40.00 | $40.00 | $712.68 |
- 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
- $1,200.00 / $5,780.00 / $13,506.00
| Facility | | $1,200.00 | $5,780.00 | $13,506.00 |