- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $732.62 / $2,574.00 / $7,215.05
| Facility | | $732.62 | $2,574.00 | $7,215.05 |
- 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
- $548.57 / $2,737.78 / $2,737.78
| Facility | | $548.57 | $2,737.78 | $2,737.78 |
- 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
- $746.00 / $2,415.00 / $7,085.00
| Facility | | $746.00 | $2,415.00 | $7,085.00 |