- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $756.00 / $2,397.00 / $4,050.00
| Facility | | $756.00 | $2,397.00 | $4,050.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,712.54 / $5,175.18 / $7,440.81
| Facility | | $2,712.54 | $5,175.18 | $7,440.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $607.78 / $2,699.98 / $2,699.98
| Facility | | $607.78 | $2,699.98 | $2,699.98 |
- 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
- $882.00 / $3,238.00 / $9,160.00
| Facility | | $882.00 | $3,238.00 | $9,160.00 |