- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $646.00 / $1,520.00 / $3,779.00
| Facility | | $646.00 | $1,520.00 | $3,779.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,302.58 / $11,526.62 / $17,695.54
| Facility | | $6,302.58 | $11,526.62 | $17,695.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $40.00 / $40.00 / $884.64
| Facility | | $40.00 | $40.00 | $884.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,802.00 / $1,802.00 / $1,802.00
| Facility | | $1,802.00 | $1,802.00 | $1,802.00 |
- 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 |