- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $728.48 / $1,893.00 / $4,559.00
| Facility | | $728.48 | $1,893.00 | $4,559.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,642.19 / $5,321.86 / $8,000.14
| Facility | | $2,642.19 | $5,321.86 | $8,000.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $40.00 / $40.00 / $535.36
| Facility | | $40.00 | $40.00 | $535.36 |
- 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 |