- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $756.00 / $2,397.00 / $4,392.00
| Facility | | $756.00 | $2,397.00 | $4,392.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,690.44 / $9,682.37 / $14,106.04
| Facility | | $5,690.44 | $9,682.37 | $14,106.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $596.03 / $3,372.27 / $3,372.27
| Facility | | $596.03 | $3,372.27 | $3,372.27 |
- 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 |