- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $760.00 / $3,576.00 / $7,500.00
| Facility | | $760.00 | $3,576.00 | $7,500.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,085.32 / $6,507.58 / $10,390.44
| Facility | | $4,085.32 | $6,507.58 | $10,390.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,266.68 / $1,266.68 / $1,266.68
| Facility | | $1,266.68 | $1,266.68 | $1,266.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $517.09 / $1,807.00 / $5,703.80
| Facility | | $517.09 | $1,807.00 | $5,703.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $884.00 / $2,900.00 / $5,543.93
| Facility | | $884.00 | $2,900.00 | $5,543.93 |