- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $698.87 / $1,850.00 / $4,050.00
| Facility | | $698.87 | $1,850.00 | $4,050.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,699.40 / $5,183.64 / $7,389.47
| Facility | | $2,699.40 | $5,183.64 | $7,389.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $585.55 / $2,408.02 / $2,408.02
| Facility | | $585.55 | $2,408.02 | $2,408.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,200.00 / $1,200.00 / $1,200.00
| Facility | | $1,200.00 | $1,200.00 | $1,200.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $882.00 / $3,238.00 / $9,160.00
| Facility | | $882.00 | $3,238.00 | $9,160.00 |