- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $957.00 / $3,742.00 / $12,600.00
| Facility | | $957.00 | $3,742.00 | $12,600.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,186.84 / $1,861.05 / $2,903.36
| Facility | | $1,186.84 | $1,861.05 | $2,903.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,937.60 / $1,937.60 / $1,937.60
| Facility | | $1,937.60 | $1,937.60 | $1,937.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $160.90 / $332.69 / $3,436.14
| Facility | | $160.90 | $332.69 | $3,436.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $575.00 / $1,928.00 / $4,012.00
| Facility | | $575.00 | $1,928.00 | $4,012.00 |