- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $453.00 / $1,520.00 / $3,728.00
| Facility | | $453.00 | $1,520.00 | $3,728.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,009.01 / $8,487.19 / $12,665.76
| Facility | | $5,009.01 | $8,487.19 | $12,665.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $287.27 / $5,517.32 / $5,517.32
| Facility | | $287.27 | $5,517.32 | $5,517.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $725.00 / $725.00 / $725.00
| Facility | | $725.00 | $725.00 | $725.00 |
- 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 |