- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $841.00 / $2,447.00 / $5,432.00
| Facility | | $841.00 | $2,447.00 | $5,432.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,699.40 / $5,842.14 / $10,692.30
| Facility | | $2,699.40 | $5,842.14 | $10,692.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $670.10 / $2,527.63 / $2,527.63
| Facility | | $670.10 | $2,527.63 | $2,527.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,400.00 / $1,400.00 / $1,400.00
| Facility | | $1,400.00 | $1,400.00 | $1,400.00 |
- 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 |