- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $803.00 / $1,083.00 / $3,109.00
| Facility | | $803.00 | $1,083.00 | $3,109.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,875.60 / $2,875.60 / $3,450.72
| Facility | | $2,875.60 | $2,875.60 | $3,450.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,187.79 / $1,187.79 / $1,187.79
| Facility | | $1,187.79 | $1,187.79 | $1,187.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,022.76 / $2,022.76 / $2,022.76
| Facility | | $2,022.76 | $2,022.76 | $2,022.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $980.00 / $2,052.00 / $6,041.11
| Facility | | $980.00 | $2,052.00 | $6,041.11 |