- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $682.00 / $3,683.00 / $7,500.00
| Facility | | $682.00 | $3,683.00 | $7,500.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,653.03 / $7,392.01 / $11,679.29
| Facility | | $4,653.03 | $7,392.01 | $11,679.29 |
- 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
- $202.27 / $375.16 / $3,910.00
| Facility | | $202.27 | $375.16 | $3,910.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $884.00 / $2,900.00 / $5,543.93
| Facility | | $884.00 | $2,900.00 | $5,543.93 |