- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $502.07 / $1,850.00 / $3,884.00
| Facility | | $502.07 | $1,850.00 | $3,884.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,699.40 / $4,762.07 / $6,752.74
| Facility | | $2,699.40 | $4,762.07 | $6,752.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $296.04 / $313.47 / $313.47
| Facility | | $296.04 | $313.47 | $313.47 |
- 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
- $746.00 / $2,415.00 / $7,085.00
| Facility | | $746.00 | $2,415.00 | $7,085.00 |