- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $710.96 / $1,850.00 / $3,884.00
| Facility | | $710.96 | $1,850.00 | $3,884.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,699.40 / $4,758.51 / $6,578.64
| Facility | | $2,699.40 | $4,758.51 | $6,578.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $477.26 / $3,826.89 / $3,826.89
| Facility | | $477.26 | $3,826.89 | $3,826.89 |
- 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 |