- 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
- $1,182.21 / $1,878.12 / $2,967.41
| Facility | | $1,182.21 | $1,878.12 | $2,967.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,351.42 / $1,351.42 / $1,351.42
| Facility | | $1,351.42 | $1,351.42 | $1,351.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $517.61 / $683.28 / $3,374.24
| Facility | | $517.61 | $683.28 | $3,374.24 |
- 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 |