- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $818.16 / $2,364.00 / $8,241.00
| Facility | | $818.16 | $2,364.00 | $8,241.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,300.93 / $5,300.93 / $6,361.12
| Facility | | $5,300.93 | $5,300.93 | $6,361.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,027.88 / $1,027.88 / $1,027.88
| Facility | | $1,027.88 | $1,027.88 | $1,027.88 |
- 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
- $2,000.00 / $4,555.00 / $8,929.00
| Facility | | $2,000.00 | $4,555.00 | $8,929.00 |