- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $762.00 / $1,850.00 / $3,945.00
| Facility | | $762.00 | $1,850.00 | $3,945.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,460.05 / $6,594.82 / $14,166.86
| Facility | | $3,460.05 | $6,594.82 | $14,166.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $753.64 / $7,524.37 / $7,524.37
| Facility | | $753.64 | $7,524.37 | $7,524.37 |
- 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
- $1,039.00 / $3,602.00 / $11,347.00
| Facility | | $1,039.00 | $3,602.00 | $11,347.00 |