- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $678.00 / $2,573.00 / $5,432.00
| Facility | | $678.00 | $2,573.00 | $5,432.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,297.79 / $4,340.72 / $6,168.35
| Facility | | $2,297.79 | $4,340.72 | $6,168.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $380.39 / $4,055.25 / $4,055.25
| Facility | | $380.39 | $4,055.25 | $4,055.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,650.00 / $1,650.00 / $1,650.00
| Facility | | $1,650.00 | $1,650.00 | $1,650.00 |
- 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 |