- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $760.00 / $2,923.00 / $7,500.00
| Facility | | $760.00 | $2,923.00 | $7,500.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,554.74 / $5,647.22 / $8,922.54
| Facility | | $3,554.74 | $5,647.22 | $8,922.54 |
- 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
- $340.29 / $475.00 / $3,910.00
| Facility | | $340.29 | $475.00 | $3,910.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $575.00 / $1,928.00 / $4,012.00
| Facility | | $575.00 | $1,928.00 | $4,012.00 |