- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $882.00 / $3,683.00 / $7,500.00
| Facility | | $882.00 | $3,683.00 | $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
- $2,545.78 / $2,545.78 / $2,545.78
| Facility | | $2,545.78 | $2,545.78 | $2,545.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $658.78 / $872.50 / $4,012.00
| Facility | | $658.78 | $872.50 | $4,012.00 |
- 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 |