- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $853.23 / $3,576.00 / $7,500.00
| Facility | | $853.23 | $3,576.00 | $7,500.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,553.52 / $1,727.70 / $2,339.69
| Facility | | $1,553.52 | $1,727.70 | $2,339.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,655.49 / $1,655.49 / $1,655.49
| Facility | | $1,655.49 | $1,655.49 | $1,655.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $805.02 / $2,495.00 / $7,992.00
| Facility | | $805.02 | $2,495.00 | $7,992.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,157.00 / $4,424.00 / $8,608.00
| Facility | | $1,157.00 | $4,424.00 | $8,608.00 |