- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $739.00 / $2,397.00 / $4,050.00
| Facility | | $739.00 | $2,397.00 | $4,050.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,371.17 / $5,009.01 / $7,389.47
| Facility | | $2,371.17 | $5,009.01 | $7,389.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $714.16 / $2,249.42 / $2,249.42
| Facility | | $714.16 | $2,249.42 | $2,249.42 |
- 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
- $882.00 / $3,238.00 / $9,160.00
| Facility | | $882.00 | $3,238.00 | $9,160.00 |