- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $736.56 / $1,958.00 / $4,559.00
| Facility | | $736.56 | $1,958.00 | $4,559.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,712.54 / $5,471.89 / $8,007.31
| Facility | | $2,712.54 | $5,471.89 | $8,007.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $40.00 / $40.00 / $542.46
| Facility | | $40.00 | $40.00 | $542.46 |
- 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 |