- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $756.00 / $2,397.00 / $4,991.00
| Facility | | $756.00 | $2,397.00 | $4,991.00 |
- 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
- $662.34 / $8,558.81 / $8,558.81
| Facility | | $662.34 | $8,558.81 | $8,558.81 |
- 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 |