- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $957.00 / $3,909.00 / $12,600.00
| Facility | | $957.00 | $3,909.00 | $12,600.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,140.21 / $6,492.10 / $10,128.21
| Facility | | $4,140.21 | $6,492.10 | $10,128.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,545.78 / $2,545.78 / $2,545.78
| Facility | | $2,545.78 | $2,545.78 | $2,545.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $374.82 / $492.09 / $5,882.00
| Facility | | $374.82 | $492.09 | $5,882.00 |
- 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 |