- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $625.00 / $3,683.00 / $7,500.00
| Facility | | $625.00 | $3,683.00 | $7,500.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,204.72 / $1,913.86 / $3,023.88
| Facility | | $1,204.72 | $1,913.86 | $3,023.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,937.60 / $1,937.60 / $1,937.60
| Facility | | $1,937.60 | $1,937.60 | $1,937.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $225.84 / $395.96 / $4,143.00
| Facility | | $225.84 | $395.96 | $4,143.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $884.00 / $3,317.00 / $5,543.93
| Facility | | $884.00 | $3,317.00 | $5,543.93 |