- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $916.00 / $3,683.00 / $8,400.00
| Facility | | $916.00 | $3,683.00 | $8,400.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,183.53 / $1,851.11 / $2,903.36
| Facility | | $1,183.53 | $1,851.11 | $2,903.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,141.83 / $1,141.83 / $1,141.83
| Facility | | $1,141.83 | $1,141.83 | $1,141.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $98.86 / $239.38 / $3,390.00
| Facility | | $98.86 | $239.38 | $3,390.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $575.00 / $1,990.00 / $4,012.00
| Facility | | $575.00 | $1,990.00 | $4,012.00 |