- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $763.00 / $2,500.00 / $8,759.19
| Facility | | $763.00 | $2,500.00 | $8,759.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,773.78 / $9,605.21 / $14,481.70
| Facility | | $5,773.78 | $9,605.21 | $14,481.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $948.56 / $8,464.19 / $8,464.19
| Facility | | $948.56 | $8,464.19 | $8,464.19 |
- 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 |