- 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
- $5,537.49 / $9,520.51 / $13,448.62
| Facility | | $5,537.49 | $9,520.51 | $13,448.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $655.16 / $8,464.19 / $8,464.19
| Facility | | $655.16 | $8,464.19 | $8,464.19 |
- 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 |