- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $597.80 / $2,397.00 / $4,050.00
| Facility | | $597.80 | $2,397.00 | $4,050.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,699.40 / $5,124.22 / $7,123.70
| Facility | | $2,699.40 | $5,124.22 | $7,123.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $451.08 / $3,116.52 / $3,116.52
| Facility | | $451.08 | $3,116.52 | $3,116.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,350.00 / $1,350.00 / $1,350.00
| Facility | | $1,350.00 | $1,350.00 | $1,350.00 |
- 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 |