- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $709.57 / $2,090.00 / $4,050.00
| Facility | | $709.57 | $2,090.00 | $4,050.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,809.77 / $9,816.98 / $14,375.82
| Facility | | $5,809.77 | $9,816.98 | $14,375.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $40.00 / $40.00 / $525.87
| Facility | | $40.00 | $40.00 | $525.87 |
- 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 |