- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $703.21 / $1,850.00 / $4,050.00
| Facility | | $703.21 | $1,850.00 | $4,050.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,284.38 / $3,842.81 / $6,018.56
| Facility | | $2,284.38 | $3,842.81 | $6,018.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $583.37 / $3,558.86 / $3,558.86
| Facility | | $583.37 | $3,558.86 | $3,558.86 |
- 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
- $470.00 / $1,429.00 / $4,123.00
| Facility | | $470.00 | $1,429.00 | $4,123.00 |