- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $802.76 / $7,838.38 / $8,763.29
| Facility | | $802.76 | $7,838.38 | $8,763.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,812.93 / $13,658.46 / $21,194.66
| Facility | | $3,812.93 | $13,658.46 | $21,194.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,700.00 / $2,700.00 / $2,700.00
| Facility | | $2,700.00 | $2,700.00 | $2,700.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $626.01 / $791.35 / $2,000.00
| Facility | | $626.01 | $791.35 | $2,000.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $790.00 / $7,773.00 / $13,891.00
| Facility | | $790.00 | $7,773.00 | $13,891.00 |