- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $756.00 / $2,500.00 / $5,203.00
| Facility | | $756.00 | $2,500.00 | $5,203.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,773.78 / $9,591.28 / $14,234.76
| Facility | | $5,773.78 | $9,591.28 | $14,234.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $40.00 / $40.00 / $710.67
| Facility | | $40.00 | $40.00 | $710.67 |
- 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 |