- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $860.00 / $2,619.41 / $5,260.00
| Facility | | $860.00 | $2,619.41 | $5,260.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,261.91 / $10,697.52 / $15,036.83
| Facility | | $6,261.91 | $10,697.52 | $15,036.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $40.00 / $40.00 / $1,564.80
| Facility | | $40.00 | $40.00 | $1,564.80 |
- 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 / $6,034.00 / $13,506.00
| Facility | | $1,200.00 | $6,034.00 | $13,506.00 |