- 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
- $2,206.73 / $3,505.71 / $5,538.99
| Facility | | $2,206.73 | $3,505.71 | $5,538.99 |
- 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
- $174.17 / $262.48 / $4,012.00
| Facility | | $174.17 | $262.48 | $4,012.00 |
- 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 |