- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $847.95 / $3,742.00 / $12,600.00
| Facility | | $847.95 | $3,742.00 | $12,600.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,739.38 / $7,431.64 / $11,593.95
| Facility | | $4,739.38 | $7,431.64 | $11,593.95 |
- 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
- $454.15 / $722.30 / $5,465.00
| Facility | | $454.15 | $722.30 | $5,465.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $884.00 / $2,900.00 / $5,543.93
| Facility | | $884.00 | $2,900.00 | $5,543.93 |