- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $756.00 / $2,212.00 / $4,991.00
| Facility | | $756.00 | $2,212.00 | $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
- $838.12 / $11,285.51 / $11,285.51
| Facility | | $838.12 | $11,285.51 | $11,285.51 |
- 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
- $1,305.00 / $7,450.00 / $24,532.00
| Facility | | $1,305.00 | $7,450.00 | $24,532.00 |