- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $738.00 / $1,850.00 / $3,945.00
| Facility | | $738.00 | $1,850.00 | $3,945.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,685.25 / $9,663.12 / $13,753.10
| Facility | | $5,685.25 | $9,663.12 | $13,753.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $686.52 / $6,124.36 / $6,124.36
| Facility | | $686.52 | $6,124.36 | $6,124.36 |
- 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 |