- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $722.10 / $1,958.00 / $4,697.00
| Facility | | $722.10 | $1,958.00 | $4,697.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,712.54 / $5,062.47 / $7,777.77
| Facility | | $2,712.54 | $5,062.47 | $7,777.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $532.08 / $3,826.89 / $3,826.89
| Facility | | $532.08 | $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
- $1,039.00 / $3,602.00 / $11,347.00
| Facility | | $1,039.00 | $3,602.00 | $11,347.00 |