- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $882.00 / $3,683.00 / $7,500.00
| Facility | | $882.00 | $3,683.00 | $7,500.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,271.00 / $9,962.39 / $15,740.47
| Facility | | $6,271.00 | $9,962.39 | $15,740.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,693.54 / $10,693.54 / $10,693.54
| Facility | | $10,693.54 | $10,693.54 | $10,693.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $386.06 / $3,662.95 / $6,627.00
| Facility | | $386.06 | $3,662.95 | $6,627.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,481.00 / $5,524.00 / $9,232.95
| Facility | | $1,481.00 | $5,524.00 | $9,232.95 |