- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $562.00 / $2,397.00 / $4,509.00
| Facility | | $562.00 | $2,397.00 | $4,509.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,343.06 / $2,835.71 / $4,442.46
| Facility | | $1,343.06 | $2,835.71 | $4,442.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $366.08 / $1,882.17 / $1,882.17
| Facility | | $366.08 | $1,882.17 | $1,882.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,350.00 / $1,350.00 / $1,350.00
| Facility | | $1,350.00 | $1,350.00 | $1,350.00 |
- 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 |