- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $652.86 / $2,397.00 / $4,050.00
| Facility | | $652.86 | $2,397.00 | $4,050.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,699.40 / $4,838.85 / $6,752.74
| Facility | | $2,699.40 | $4,838.85 | $6,752.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $493.68 / $2,978.09 / $2,978.09
| Facility | | $493.68 | $2,978.09 | $2,978.09 |
- 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 |