- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $498.08 / $2,095.00 / $7,838.38
| Facility | | $498.08 | $2,095.00 | $7,838.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,094.42 / $7,252.42 / $11,254.02
| Facility | | $2,094.42 | $7,252.42 | $11,254.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,800.00 / $3,800.00 / $3,800.00
| Facility | | $3,800.00 | $3,800.00 | $3,800.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $405.56 / $558.91 / $2,100.00
| Facility | | $405.56 | $558.91 | $2,100.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $639.00 / $5,971.00 / $8,422.00
| Facility | | $639.00 | $5,971.00 | $8,422.00 |