- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $900.00 / $4,864.00 / $9,850.70
| Facility | | $900.00 | $4,864.00 | $9,850.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,594.62 / $10,480.21 / $16,871.59
| Facility | | $8,594.62 | $10,480.21 | $16,871.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,601.00 / $5,601.00 / $5,601.00
| Facility | | $5,601.00 | $5,601.00 | $5,601.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,497.82 / $9,108.60 / $14,336.66
| Facility | | $7,497.82 | $9,108.60 | $14,336.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,334.00 / $7,226.00 / $12,939.96
| Facility | | $2,334.00 | $7,226.00 | $12,939.96 |