- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $933.25 / $3,090.30 / $10,000.00
| Facility | | $933.25 | $3,090.30 | $10,000.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,659.59 / $3,981.07 / $5,888.44
| Facility | | $1,659.59 | $3,981.07 | $5,888.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $512.86 / $912.01 / $3,162.28
| Facility | | $512.86 | $912.01 | $3,162.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,943.28 / $7,943.28 / $42,657.95
| Facility | | $7,943.28 | $7,943.28 | $42,657.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,174.90 / $3,548.13 / $6,025.60
| Facility | | $1,174.90 | $3,548.13 | $6,025.60 |