- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $738.00 / $1,850.00 / $3,945.00
| Facility | | $738.00 | $1,850.00 | $3,945.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,685.25 / $9,605.21 / $13,753.10
| Facility | | $5,685.25 | $9,605.21 | $13,753.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $567.51 / $5,281.24 / $5,281.24
| Facility | | $567.51 | $5,281.24 | $5,281.24 |
- 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
- $1,141.00 / $4,717.00 / $11,696.00
| Facility | | $1,141.00 | $4,717.00 | $11,696.00 |