- 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
- $5,114.57 / $9,145.96 / $13,354.75
| Facility | | $5,114.57 | $9,145.96 | $13,354.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $771.90 / $7,618.52 / $7,618.52
| Facility | | $771.90 | $7,618.52 | $7,618.52 |
- 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 |