- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $762.00 / $1,958.00 / $4,559.00
| Facility | | $762.00 | $1,958.00 | $4,559.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,806.57 / $9,605.21 / $14,756.27
| Facility | | $5,806.57 | $9,605.21 | $14,756.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $40.00 / $40.00 / $900.12
| Facility | | $40.00 | $40.00 | $900.12 |
- 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 |