- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $750.00 / $3,612.00 / $7,500.00
| Facility | | $750.00 | $3,612.00 | $7,500.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,064.77 / $6,457.50 / $10,202.77
| Facility | | $4,064.77 | $6,457.50 | $10,202.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,351.42 / $1,351.42 / $1,351.42
| Facility | | $1,351.42 | $1,351.42 | $1,351.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $354.20 / $511.75 / $2,974.00
| Facility | | $354.20 | $511.75 | $2,974.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $575.00 / $2,072.00 / $4,012.00
| Facility | | $575.00 | $2,072.00 | $4,012.00 |