- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $574.08 / $2,397.00 / $4,050.00
| Facility | | $574.08 | $2,397.00 | $4,050.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,642.19 / $5,096.85 / $7,123.70
| Facility | | $2,642.19 | $5,096.85 | $7,123.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $424.08 / $1,751.30 / $1,751.30
| Facility | | $424.08 | $1,751.30 | $1,751.30 |
- 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 |