- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $756.00 / $2,397.00 / $4,509.00
| Facility | | $756.00 | $2,397.00 | $4,509.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,212.84 / $12,457.66 / $26,517.16
| Facility | | $6,212.84 | $12,457.66 | $26,517.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $906.51 / $13,083.91 / $13,083.91
| Facility | | $906.51 | $13,083.91 | $13,083.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,350.00 / $1,350.00 / $1,350.00
| Facility | | $1,350.00 | $1,350.00 | $1,350.00 |
- 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 |