- 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
- $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
- $1,491.09 / $1,491.09 / $1,491.09
| Facility | | $1,491.09 | $1,491.09 | $1,491.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $454.62 / $697.64 / $5,246.20
| Facility | | $454.62 | $697.64 | $5,246.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $880.00 / $3,317.00 / $5,543.93
| Facility | | $880.00 | $3,317.00 | $5,543.93 |