- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $937.68 / $3,145.00 / $8,400.00
| Facility | | $937.68 | $3,145.00 | $8,400.00 |
- 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
- $168.76 / $976.64 / $4,918.70
| Facility | | $168.76 | $976.64 | $4,918.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $942.00 / $3,680.00 / $5,847.50
| Facility | | $942.00 | $3,680.00 | $5,847.50 |