- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $973.50 / $1,688.00 / $8,912.31
| Facility | | $973.50 | $1,688.00 | $8,912.31 |
- 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
- $1,155.23 / $1,259.66 / $3,602.59
| Facility | | $1,155.23 | $1,259.66 | $3,602.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,945.86 / $8,945.86 / $8,945.86
| Facility | | $8,945.86 | $8,945.86 | $8,945.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,104.00 / $4,663.00 / $10,818.00
| Facility | | $2,104.00 | $4,663.00 | $10,818.00 |