- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $762.00 / $1,958.00 / $5,607.00
| Facility | | $762.00 | $1,958.00 | $5,607.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,972.60 / $5,588.50 / $8,874.29
| Facility | | $2,972.60 | $5,588.50 | $8,874.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $600.67 / $2,678.82 / $2,678.82
| Facility | | $600.67 | $2,678.82 | $2,678.82 |
- 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
- $1,039.00 / $3,722.00 / $9,060.41
| Facility | | $1,039.00 | $3,722.00 | $9,060.41 |