- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $465.06 / $2,877.00 / $4,933.00
| Facility | | $465.06 | $2,877.00 | $4,933.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,481.94 / $4,157.67 / $5,878.86
| Facility | | $3,481.94 | $4,157.67 | $5,878.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $595.50 / $595.50 / $595.50
| Facility | | $595.50 | $595.50 | $595.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,198.65 / $2,877.00 / $4,933.00
| Facility | | $2,198.65 | $2,877.00 | $4,933.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,000.00 / $10,192.00 / $12,767.00
| Facility | | $5,000.00 | $10,192.00 | $12,767.00 |