- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $711.02 / $2,090.00 / $4,050.00
| Facility | | $711.02 | $2,090.00 | $4,050.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,809.77 / $9,787.73 / $14,011.88
| Facility | | $5,809.77 | $9,787.73 | $14,011.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $528.27 / $5,542.06 / $5,542.06
| Facility | | $528.27 | $5,542.06 | $5,542.06 |
- 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 |