- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $739.00 / $2,415.88 / $4,509.00
| Facility | | $739.00 | $2,415.88 | $4,509.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,880.28 / $12,906.32 / $26,164.90
| Facility | | $6,880.28 | $12,906.32 | $26,164.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $711.60 / $7,229.48 / $7,229.48
| Facility | | $711.60 | $7,229.48 | $7,229.48 |
- 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 |