- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $587.27 / $1,958.00 / $4,559.00
| Facility | | $587.27 | $1,958.00 | $4,559.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,377.69 / $4,762.07 / $7,653.66
| Facility | | $2,377.69 | $4,762.07 | $7,653.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $40.00 / $40.00 / $426.81
| Facility | | $40.00 | $40.00 | $426.81 |
- 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 |