- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $837.00 / $2,500.00 / $4,991.00
| Facility | | $837.00 | $2,500.00 | $4,991.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,699.40 / $5,183.64 / $7,389.47
| Facility | | $2,699.40 | $5,183.64 | $7,389.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $760.46 / $2,468.48 / $2,468.48
| Facility | | $760.46 | $2,468.48 | $2,468.48 |
- 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 |