- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,039.55 / $3,683.00 / $8,400.00
| Facility | | $1,039.55 | $3,683.00 | $8,400.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,585.95 / $10,462.75 / $16,531.03
| Facility | | $6,585.95 | $10,462.75 | $16,531.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,008.88 / $6,008.88 / $6,008.88
| Facility | | $6,008.88 | $6,008.88 | $6,008.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $927.80 / $1,408.89 / $5,543.93
| Facility | | $927.80 | $1,408.89 | $5,543.93 |
- 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 |