- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $916.00 / $3,683.00 / $8,400.00
| Facility | | $916.00 | $3,683.00 | $8,400.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,873.50 / $12,508.22 / $19,762.84
| Facility | | $7,873.50 | $12,508.22 | $19,762.84 |
- 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
- $253.59 / $482.08 / $4,596.00
| Facility | | $253.59 | $482.08 | $4,596.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $884.00 / $3,363.00 / $6,167.00
| Facility | | $884.00 | $3,363.00 | $6,167.00 |