- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $794.33 / $3,162.28 / $3,162.28
| Facility | | $794.33 | $3,162.28 | $3,162.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $28.18 / $363.08 / $1,584.89
| Facility | | $28.18 | $363.08 | $1,584.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $100.00 / $5,128.61 / $5,128.61
| Facility | | $100.00 | $5,128.61 | $5,128.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,000.00 / $1,513.56 / $1,513.56
| Facility | | $1,000.00 | $1,513.56 | $1,513.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,000.00 / $1,513.56 / $1,513.56
| Facility | | $1,000.00 | $1,513.56 | $1,513.56 |