- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,030.33 / $3,500.00 / $8,435.00
| Facility | | $1,030.33 | $3,500.00 | $8,435.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,242.09 / $9,242.09 / $11,090.51
| Facility | | $9,242.09 | $9,242.09 | $11,090.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,302.48 / $1,302.48 / $1,302.48
| Facility | | $1,302.48 | $1,302.48 | $1,302.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,726.62 / $4,726.62 / $4,726.62
| Facility | | $4,726.62 | $4,726.62 | $4,726.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,104.00 / $4,334.00 / $8,676.00
| Facility | | $2,104.00 | $4,334.00 | $8,676.00 |