- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $458.76 / $1,520.00 / $3,685.00
| Facility | | $458.76 | $1,520.00 | $3,685.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,534.06 / $5,533.66 / $10,692.30
| Facility | | $2,534.06 | $5,533.66 | $10,692.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $375.00 / $3,710.39 / $3,710.39
| Facility | | $375.00 | $3,710.39 | $3,710.39 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $725.00 / $725.00 / $725.00
| Facility | | $725.00 | $725.00 | $725.00 |
- 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 |