- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $860.00 / $2,448.00 / $5,687.00
| Facility | | $860.00 | $2,448.00 | $5,687.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,783.10 / $8,708.16 / $12,075.88
| Facility | | $4,783.10 | $8,708.16 | $12,075.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $942.07 / $2,434.82 / $2,434.82
| Facility | | $942.07 | $2,434.82 | $2,434.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,650.00 / $1,650.00 / $1,650.00
| Facility | | $1,650.00 | $1,650.00 | $1,650.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,141.00 / $4,717.00 / $11,696.00
| Facility | | $1,141.00 | $4,717.00 | $11,696.00 |