- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $756.00 / $2,397.00 / $4,991.00
| Facility | | $756.00 | $2,397.00 | $4,991.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,429.16 / $12,571.91 / $27,360.92
| Facility | | $6,429.16 | $12,571.91 | $27,360.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $800.71 / $16,662.68 / $16,662.68
| Facility | | $800.71 | $16,662.68 | $16,662.68 |
- 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 |