- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $400.00 / $1,520.00 / $3,685.00
| Facility | | $400.00 | $1,520.00 | $3,685.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,435.37 / $8,615.26 / $12,356.53
| Facility | | $4,435.37 | $8,615.26 | $12,356.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $166.72 / $4,444.54 / $4,444.54
| Facility | | $166.72 | $4,444.54 | $4,444.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $212.98 / $525.00 / $5,570.52
| Facility | | $212.98 | $525.00 | $5,570.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $868.00 / $3,238.00 / $8,488.00
| Facility | | $868.00 | $3,238.00 | $8,488.00 |