- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $712.51 / $2,212.00 / $4,509.00
| Facility | | $712.51 | $2,212.00 | $4,509.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,308.22 / $2,728.26 / $4,442.46
| Facility | | $1,308.22 | $2,728.26 | $4,442.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $604.72 / $4,293.62 / $4,293.62
| Facility | | $604.72 | $4,293.62 | $4,293.62 |
- 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
- $470.00 / $1,429.00 / $4,123.00
| Facility | | $470.00 | $1,429.00 | $4,123.00 |