- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $871.50 / $3,281.00 / $8,400.00
| Facility | | $871.50 | $3,281.00 | $8,400.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,442.39 / $3,003.20 / $3,791.54
| Facility | | $1,442.39 | $3,003.20 | $3,791.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $800.00 / $2,375.00 / $8,757.00
| Facility | | $800.00 | $2,375.00 | $8,757.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $368.26 / $584.38 / $4,423.00
| Facility | | $368.26 | $584.38 | $4,423.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,037.00 / $3,096.00 / $5,562.00
| Facility | | $1,037.00 | $3,096.00 | $5,562.00 |