- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $732.00 / $2,397.00 / $4,050.00
| Facility | | $732.00 | $2,397.00 | $4,050.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,753.58 / $4,550.27 / $6,981.81
| Facility | | $1,753.58 | $4,550.27 | $6,981.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $502.27 / $2,800.55 / $2,800.55
| Facility | | $502.27 | $2,800.55 | $2,800.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $604.55 / $901.00 / $1,936.96
| Facility | | $604.55 | $901.00 | $1,936.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $826.00 / $2,889.00 / $6,661.00
| Facility | | $826.00 | $2,889.00 | $6,661.00 |