- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $441.00 / $2,211.51 / $3,981.09
| Facility | | $441.00 | $2,211.51 | $3,981.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,729.42 / $3,762.32 / $7,383.33
| Facility | | $1,729.42 | $3,762.32 | $7,383.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $480.00 / $2,003.99 / $3,771.82
| Facility | | $480.00 | $2,003.99 | $3,771.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $980.00 / $2,987.01 / $4,771.82
| Facility | | $980.00 | $2,987.01 | $4,771.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $980.00 / $3,357.04 / $5,386.01
| Facility | | $980.00 | $3,357.04 | $5,386.01 |