- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $800.00 / $2,992.00 / $8,400.00
| Facility | | $800.00 | $2,992.00 | $8,400.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,646.01 / $4,944.21 / $7,161.81
| Facility | | $3,646.01 | $4,944.21 | $7,161.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $585.54 / $585.54 / $585.54
| Facility | | $585.54 | $585.54 | $585.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $453.77 / $2,485.65 / $8,072.00
| Facility | | $453.77 | $2,485.65 | $8,072.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,851.00 / $6,980.00 / $13,541.98
| Facility | | $1,851.00 | $6,980.00 | $13,541.98 |