- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $762.00 / $1,958.00 / $5,607.00
| Facility | | $762.00 | $1,958.00 | $5,607.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,685.25 / $9,682.37 / $13,982.44
| Facility | | $5,685.25 | $9,682.37 | $13,982.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $688.67 / $5,853.68 / $5,853.68
| Facility | | $688.67 | $5,853.68 | $5,853.68 |
- 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 |