- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $804.50 / $3,576.00 / $8,400.00
| Facility | | $804.50 | $3,576.00 | $8,400.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,904.89 / $6,203.47 / $9,801.42
| Facility | | $3,904.89 | $6,203.47 | $9,801.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,937.60 / $1,937.60 / $1,937.60
| Facility | | $1,937.60 | $1,937.60 | $1,937.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $570.67 / $761.74 / $4,393.26
| Facility | | $570.67 | $761.74 | $4,393.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $575.00 / $1,928.00 / $4,012.00
| Facility | | $575.00 | $1,928.00 | $4,012.00 |