- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $625.00 / $2,876.00 / $7,500.00
| Facility | | $625.00 | $2,876.00 | $7,500.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,742.32 / $2,748.15 / $4,373.29
| Facility | | $1,742.32 | $2,748.15 | $4,373.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,070.25 / $1,070.25 / $1,070.25
| Facility | | $1,070.25 | $1,070.25 | $1,070.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $116.44 / $358.19 / $5,477.56
| Facility | | $116.44 | $358.19 | $5,477.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $884.00 / $2,900.00 / $5,543.93
| Facility | | $884.00 | $2,900.00 | $5,543.93 |