- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $636.41 / $2,397.00 / $4,392.00
| Facility | | $636.41 | $2,397.00 | $4,392.00 |
- 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
- $472.18 / $2,397.53 / $2,397.53
| Facility | | $472.18 | $2,397.53 | $2,397.53 |
- 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 |