- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $724.72 / $1,958.00 / $4,559.00
| Facility | | $724.72 | $1,958.00 | $4,559.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,630.61 / $7,653.66 / $13,753.10
| Facility | | $3,630.61 | $7,653.66 | $13,753.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $533.40 / $5,680.37 / $5,680.37
| Facility | | $533.40 | $5,680.37 | $5,680.37 |
- 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 |