- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $762.00 / $2,125.00 / $12,328.00
| Facility | | $762.00 | $2,125.00 | $12,328.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,685.25 / $9,557.75 / $14,106.04
| Facility | | $5,685.25 | $9,557.75 | $14,106.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $928.16 / $8,634.94 / $8,634.94
| Facility | | $928.16 | $8,634.94 | $8,634.94 |
- 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 |