- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $728.48 / $2,060.00 / $5,525.00
| Facility | | $728.48 | $2,060.00 | $5,525.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,699.40 / $5,349.85 / $8,000.14
| Facility | | $2,699.40 | $5,349.85 | $8,000.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $538.51 / $3,634.58 / $3,634.58
| Facility | | $538.51 | $3,634.58 | $3,634.58 |
- 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 |