- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $617.79 / $1,893.00 / $4,559.00
| Facility | | $617.79 | $1,893.00 | $4,559.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,642.19 / $4,927.64 / $7,653.66
| Facility | | $2,642.19 | $4,927.64 | $7,653.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $458.10 / $2,837.51 / $2,837.51
| Facility | | $458.10 | $2,837.51 | $2,837.51 |
- 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
- $882.00 / $3,238.00 / $9,160.00
| Facility | | $882.00 | $3,238.00 | $9,160.00 |