- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $762.00 / $1,850.00 / $4,559.00
| Facility | | $762.00 | $1,850.00 | $4,559.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,685.25 / $9,605.21 / $13,753.10
| Facility | | $5,685.25 | $9,605.21 | $13,753.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $686.30 / $5,746.31 / $5,746.31
| Facility | | $686.30 | $5,746.31 | $5,746.31 |
- 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 |