- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $813.01 / $2,500.00 / $5,203.00
| Facility | | $813.01 | $2,500.00 | $5,203.00 |
- 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
- $598.54 / $3,008.29 / $3,008.29
| Facility | | $598.54 | $3,008.29 | $3,008.29 |
- 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
- $882.00 / $3,238.00 / $9,160.00
| Facility | | $882.00 | $3,238.00 | $9,160.00 |