- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $933.25 / $2,818.38 / $6,606.93
| Facility | | $933.25 | $2,818.38 | $6,606.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,317.64 / $14,125.38 / $27,542.29
| Facility | | $8,317.64 | $14,125.38 | $27,542.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $39.81 / $39.81 / $1,230.27
| Facility | | $39.81 | $39.81 | $1,230.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $398.11 / $398.11 / $398.11
| Facility | | $398.11 | $398.11 | $398.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,202.26 / $10,000.00 / $26,302.68
| Facility | | $1,202.26 | $10,000.00 | $26,302.68 |