- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $593.50 / $3,578.00 / $7,500.00
| Facility | | $593.50 | $3,578.00 | $7,500.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,513.12 / $2,366.61 / $3,711.90
| Facility | | $1,513.12 | $2,366.61 | $3,711.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,141.83 / $1,141.83 / $1,141.83
| Facility | | $1,141.83 | $1,141.83 | $1,141.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $362.54 / $610.77 / $2,025.88
| Facility | | $362.54 | $610.77 | $2,025.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $375.00 / $1,325.00 / $2,637.00
| Facility | | $375.00 | $1,325.00 | $2,637.00 |