- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $920.72 / $4,376.00 / $12,600.00
| Facility | | $920.72 | $4,376.00 | $12,600.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,461.10 / $2,151.96 / $4,532.06
| Facility | | $1,461.10 | $2,151.96 | $4,532.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $505.00 / $505.00 / $505.00
| Facility | | $505.00 | $505.00 | $505.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $678.10 / $1,076.46 / $11,642.00
| Facility | | $678.10 | $1,076.46 | $11,642.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,269.00 / $6,407.00 / $12,989.00
| Facility | | $2,269.00 | $6,407.00 | $12,989.00 |