- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $988.30 / $3,684.00 / $12,600.00
| Facility | | $988.30 | $3,684.00 | $12,600.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,719.49 / $2,739.02 / $4,373.29
| Facility | | $1,719.49 | $2,739.02 | $4,373.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,070.25 / $1,070.25 / $1,070.25
| Facility | | $1,070.25 | $1,070.25 | $1,070.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $548.34 / $1,169.08 / $5,834.42
| Facility | | $548.34 | $1,169.08 | $5,834.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $884.00 / $2,875.93 / $5,543.93
| Facility | | $884.00 | $2,875.93 | $5,543.93 |