- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $837.86 / $2,726.00 / $6,388.21
| Facility | | $837.86 | $2,726.00 | $6,388.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,601.67 / $4,822.02 / $7,653.66
| Facility | | $2,601.67 | $4,822.02 | $7,653.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $621.67 / $2,482.10 / $2,482.10
| Facility | | $621.67 | $2,482.10 | $2,482.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,400.00 / $1,400.00 / $1,400.00
| Facility | | $1,400.00 | $1,400.00 | $1,400.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,200.00 / $5,780.00 / $13,506.00
| Facility | | $1,200.00 | $5,780.00 | $13,506.00 |