- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $956.00 / $1,632.00 / $4,807.78
| Facility | | $956.00 | $1,632.00 | $4,807.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,727.30 / $6,727.30 / $8,072.76
| Facility | | $6,727.30 | $6,727.30 | $8,072.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,087.68 / $1,185.52 / $3,319.05
| Facility | | $1,087.68 | $1,185.52 | $3,319.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,926.18 / $4,926.18 / $4,926.18
| Facility | | $4,926.18 | $4,926.18 | $4,926.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,104.00 / $4,990.00 / $14,407.00
| Facility | | $2,104.00 | $4,990.00 | $14,407.00 |