- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $762.00 / $1,893.00 / $7,209.00
| Facility | | $762.00 | $1,893.00 | $7,209.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,685.25 / $10,098.87 / $14,089.68
| Facility | | $5,685.25 | $10,098.87 | $14,089.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $645.48 / $7,311.20 / $7,311.20
| Facility | | $645.48 | $7,311.20 | $7,311.20 |
- 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 |