- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $762.00 / $1,881.73 / $4,050.00
| Facility | | $762.00 | $1,881.73 | $4,050.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,898.80 / $10,230.67 / $14,577.45
| Facility | | $5,898.80 | $10,230.67 | $14,577.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,032.46 / $8,265.73 / $8,265.73
| Facility | | $1,032.46 | $8,265.73 | $8,265.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,802.00 / $1,802.00 / $1,802.00
| Facility | | $1,802.00 | $1,802.00 | $1,802.00 |
- 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 |