- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $762.00 / $1,958.00 / $5,432.00
| Facility | | $762.00 | $1,958.00 | $5,432.00 |
- 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
- $765.81 / $2,687.03 / $2,687.03
| Facility | | $765.81 | $2,687.03 | $2,687.03 |
- 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 |