- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $625.00 / $3,576.00 / $7,500.00
| Facility | | $625.00 | $3,576.00 | $7,500.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,182.21 / $1,878.12 / $2,967.41
| Facility | | $1,182.21 | $1,878.12 | $2,967.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $207.85 / $207.85 / $207.85
| Facility | | $207.85 | $207.85 | $207.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $461.00 / $601.09 / $1,619.30
| Facility | | $461.00 | $601.09 | $1,619.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $139.00 / $610.00 / $1,883.00
| Facility | | $139.00 | $610.00 | $1,883.00 |