- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $650.84 / $3,683.00 / $7,500.00
| Facility | | $650.84 | $3,683.00 | $7,500.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,182.21 / $1,878.12 / $2,967.41
| Facility | | $1,182.21 | $1,878.12 | $2,967.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,545.78 / $2,545.78 / $2,545.78
| Facility | | $2,545.78 | $2,545.78 | $2,545.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $608.91 / $797.28 / $2,974.00
| Facility | | $608.91 | $797.28 | $2,974.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $575.00 / $2,072.00 / $4,012.00
| Facility | | $575.00 | $2,072.00 | $4,012.00 |