- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $876.79 / $2,472.00 / $4,991.00
| Facility | | $876.79 | $2,472.00 | $4,991.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,601.67 / $5,047.04 / $7,123.70
| Facility | | $2,601.67 | $5,047.04 | $7,123.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $657.93 / $2,771.35 / $2,771.35
| Facility | | $657.93 | $2,771.35 | $2,771.35 |
- 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
- $882.00 / $3,238.00 / $9,160.00
| Facility | | $882.00 | $3,238.00 | $9,160.00 |