- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $640.00 / $2,397.00 / $4,050.00
| Facility | | $640.00 | $2,397.00 | $4,050.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,312.57 / $4,256.72 / $8,124.40
| Facility | | $2,312.57 | $4,256.72 | $8,124.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,157.64 / $2,157.64 / $2,157.64
| Facility | | $2,157.64 | $2,157.64 | $2,157.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $848.00 / $848.00 / $848.00
| Facility | | $848.00 | $848.00 | $848.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $826.00 / $2,736.80 / $6,368.82
| Facility | | $826.00 | $2,736.80 | $6,368.82 |