- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $358.46 / $1,850.00 / $4,392.00
| Facility | | $358.46 | $1,850.00 | $4,392.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,238.19 / $3,773.96 / $5,613.80
| Facility | | $2,238.19 | $3,773.96 | $5,613.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $143.08 / $3,204.05 / $3,204.05
| Facility | | $143.08 | $3,204.05 | $3,204.05 |
- 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
- $470.00 / $1,429.00 / $4,123.00
| Facility | | $470.00 | $1,429.00 | $4,123.00 |