- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $622.50 / $4,376.00 / $12,600.00
| Facility | | $622.50 | $4,376.00 | $12,600.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,339.50 / $1,881.58 / $3,130.84
| Facility | | $1,339.50 | $1,881.58 | $3,130.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $505.00 / $505.00 / $505.00
| Facility | | $505.00 | $505.00 | $505.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $417.31 / $654.11 / $3,331.00
| Facility | | $417.31 | $654.11 | $3,331.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $825.00 / $2,081.00 / $3,918.00
| Facility | | $825.00 | $2,081.00 | $3,918.00 |