- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $663.87 / $2,397.00 / $4,392.00
| Facility | | $663.87 | $2,397.00 | $4,392.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,712.54 / $4,965.46 / $6,815.16
| Facility | | $2,712.54 | $4,965.46 | $6,815.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $492.21 / $3,776.13 / $3,776.13
| Facility | | $492.21 | $3,776.13 | $3,776.13 |
- 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
- $746.00 / $2,415.00 / $7,085.00
| Facility | | $746.00 | $2,415.00 | $7,085.00 |