- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $739.00 / $2,418.00 / $5,289.28
| Facility | | $739.00 | $2,418.00 | $5,289.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,522.69 / $4,245.51 / $6,293.67
| Facility | | $2,522.69 | $4,245.51 | $6,293.67 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $657.37 / $3,237.26 / $3,237.26
| Facility | | $657.37 | $3,237.26 | $3,237.26 |
- 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 |