- 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
- $3,794.37 / $6,027.89 / $9,524.00
| Facility | | $3,794.37 | $6,027.89 | $9,524.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $770.49 / $770.49 / $770.49
| Facility | | $770.49 | $770.49 | $770.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $150.41 / $327.78 / $2,038.67
| Facility | | $150.41 | $327.78 | $2,038.67 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $375.00 / $1,325.00 / $2,637.00
| Facility | | $375.00 | $1,325.00 | $2,637.00 |