- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $762.00 / $1,850.00 / $4,050.00
| Facility | | $762.00 | $1,850.00 | $4,050.00 |
- 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
- $603.51 / $1,192.82 / $1,192.82
| Facility | | $603.51 | $1,192.82 | $1,192.82 |
- 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 / $7,450.00 / $15,847.00
| Facility | | $1,305.00 | $7,450.00 | $15,847.00 |