- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $763.00 / $2,312.00 / $5,812.52
| Facility | | $763.00 | $2,312.00 | $5,812.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,699.40 / $4,991.74 / $7,653.66
| Facility | | $2,699.40 | $4,991.74 | $7,653.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $625.41 / $3,826.89 / $3,826.89
| Facility | | $625.41 | $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
- $882.00 / $3,238.00 / $9,160.00
| Facility | | $882.00 | $3,238.00 | $9,160.00 |