- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $957.00 / $3,684.00 / $12,600.00
| Facility | | $957.00 | $3,684.00 | $12,600.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,128.68 / $6,457.50 / $10,128.21
| Facility | | $4,128.68 | $6,457.50 | $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
- $392.16 / $536.79 / $5,882.00
| Facility | | $392.16 | $536.79 | $5,882.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $884.00 / $3,317.00 / $5,543.93
| Facility | | $884.00 | $3,317.00 | $5,543.93 |