- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $891.25 / $2,691.53 / $6,606.93
| Facility | | $891.25 | $2,691.53 | $6,606.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,232.93 / $17,378.01 / $26,915.35
| Facility | | $10,232.93 | $17,378.01 | $26,915.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $39.81 / $12,302.69 / $12,302.69
| Facility | | $39.81 | $12,302.69 | $12,302.69 |
- 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 / $25,703.96
| Facility | | $1,202.26 | $10,000.00 | $25,703.96 |