- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $500.00 / $2,923.00 / $6,435.00
| Facility | | $500.00 | $2,923.00 | $6,435.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,247.69 / $3,524.51 / $5,498.52
| Facility | | $2,247.69 | $3,524.51 | $5,498.52 |
- 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
- $158.97 / $225.37 / $3,910.00
| Facility | | $158.97 | $225.37 | $3,910.00 |
- 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 |