- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $762.00 / $1,958.00 / $4,878.00
| Facility | | $762.00 | $1,958.00 | $4,878.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,685.25 / $9,682.37 / $13,982.44
| Facility | | $5,685.25 | $9,682.37 | $13,982.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $898.55 / $7,433.11 / $7,433.11
| Facility | | $898.55 | $7,433.11 | $7,433.11 |
- 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
- $1,305.00 / $7,100.00 / $22,240.00
| Facility | | $1,305.00 | $7,100.00 | $22,240.00 |