- 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
- $3,966.27 / $6,203.47 / $9,729.79
| Facility | | $3,966.27 | $6,203.47 | $9,729.79 |
- 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
- $575.27 / $860.00 / $4,393.26
| Facility | | $575.27 | $860.00 | $4,393.26 |
- 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 |