- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $623.85 / $2,167.00 / $5,150.00
| Facility | | $623.85 | $2,167.00 | $5,150.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,712.54 / $4,838.85 / $6,815.16
| Facility | | $2,712.54 | $4,838.85 | $6,815.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $420.72 / $2,922.44 / $2,922.44
| Facility | | $420.72 | $2,922.44 | $2,922.44 |
- 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 |