- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $548.04 / $2,082.00 / $4,050.00
| Facility | | $548.04 | $2,082.00 | $4,050.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,659.52 / $3,313.02 / $5,029.27
| Facility | | $1,659.52 | $3,313.02 | $5,029.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $335.51 / $1,342.46 / $1,342.46
| Facility | | $335.51 | $1,342.46 | $1,342.46 |
- 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 |