- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $719.06 / $2,892.00 / $7,209.00
| Facility | | $719.06 | $2,892.00 | $7,209.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,712.54 / $6,018.56 / $10,692.30
| Facility | | $2,712.54 | $6,018.56 | $10,692.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $443.22 / $3,825.02 / $3,825.02
| Facility | | $443.22 | $3,825.02 | $3,825.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,650.00 / $1,650.00 / $1,650.00
| Facility | | $1,650.00 | $1,650.00 | $1,650.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $746.00 / $2,415.00 / $7,085.00
| Facility | | $746.00 | $2,415.00 | $7,085.00 |