- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $724.21 / $2,447.00 / $5,260.00
| Facility | | $724.21 | $2,447.00 | $5,260.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,699.40 / $5,800.66 / $10,332.54
| Facility | | $2,699.40 | $5,800.66 | $10,332.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $548.74 / $2,742.08 / $2,742.08
| Facility | | $548.74 | $2,742.08 | $2,742.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,400.00 / $1,400.00 / $1,400.00
| Facility | | $1,400.00 | $1,400.00 | $1,400.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $882.00 / $3,238.00 / $9,160.00
| Facility | | $882.00 | $3,238.00 | $9,160.00 |