- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $795.91 / $7,838.38 / $8,763.29
| Facility | | $795.91 | $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
- $626.95 / $783.49 / $2,000.00
| Facility | | $626.95 | $783.49 | $2,000.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,300.00 / $8,084.00 / $10,150.00
| Facility | | $1,300.00 | $8,084.00 | $10,150.00 |