- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $957.00 / $3,779.00 / $12,600.00
| Facility | | $957.00 | $3,779.00 | $12,600.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,068.33 / $6,436.20 / $10,074.96
| Facility | | $4,068.33 | $6,436.20 | $10,074.96 |
- 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
- $395.28 / $618.48 / $4,596.00
| Facility | | $395.28 | $618.48 | $4,596.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $884.00 / $3,363.00 / $6,167.00
| Facility | | $884.00 | $3,363.00 | $6,167.00 |