- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $741.22 / $1,850.00 / $4,050.00
| Facility | | $741.22 | $1,850.00 | $4,050.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,062.09 / $7,360.79 / $13,753.10
| Facility | | $4,062.09 | $7,360.79 | $13,753.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $560.20 / $5,606.43 / $5,606.43
| Facility | | $560.20 | $5,606.43 | $5,606.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,200.00 / $1,200.00 / $1,200.00
| Facility | | $1,200.00 | $1,200.00 | $1,200.00 |
- 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 |