- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $762.00 / $1,850.00 / $4,050.00
| Facility | | $762.00 | $1,850.00 | $4,050.00 |
- 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
- $823.58 / $5,245.52 / $5,245.52
| Facility | | $823.58 | $5,245.52 | $5,245.52 |
- 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
- $1,200.00 / $5,780.00 / $13,506.00
| Facility | | $1,200.00 | $5,780.00 | $13,506.00 |