- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $916.00 / $3,683.00 / $8,400.00
| Facility | | $916.00 | $3,683.00 | $8,400.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,891.84 / $3,005.44 / $4,748.57
| Facility | | $1,891.84 | $3,005.44 | $4,748.57 |
- 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
- $393.15 / $570.79 / $4,232.60
| Facility | | $393.15 | $570.79 | $4,232.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $884.00 / $2,900.00 / $5,543.93
| Facility | | $884.00 | $2,900.00 | $5,543.93 |