- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $535.00 / $1,520.00 / $4,154.00
| Facility | | $535.00 | $1,520.00 | $4,154.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,114.57 / $9,605.21 / $13,742.29
| Facility | | $5,114.57 | $9,605.21 | $13,742.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $596.72 / $4,967.20 / $4,967.20
| Facility | | $596.72 | $4,967.20 | $4,967.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $725.00 / $725.00 / $725.00
| Facility | | $725.00 | $725.00 | $725.00 |
- 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 |