- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $738.00 / $1,869.00 / $5,607.00
| Facility | | $738.00 | $1,869.00 | $5,607.00 |
- 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
- $660.16 / $5,351.68 / $5,351.68
| Facility | | $660.16 | $5,351.68 | $5,351.68 |
- 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 |