- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $957.00 / $3,683.00 / $12,600.00
| Facility | | $957.00 | $3,683.00 | $12,600.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,227.34 / $8,304.37 / $13,120.82
| Facility | | $5,227.34 | $8,304.37 | $13,120.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,351.42 / $1,351.42 / $1,351.42
| Facility | | $1,351.42 | $1,351.42 | $1,351.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $516.25 / $707.13 / $4,132.00
| Facility | | $516.25 | $707.13 | $4,132.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $575.00 / $1,990.00 / $4,012.00
| Facility | | $575.00 | $1,990.00 | $4,012.00 |