- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $668.41 / $2,095.00 / $7,838.38
| Facility | | $668.41 | $2,095.00 | $7,838.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,467.27 / $8,543.52 / $13,257.49
| Facility | | $2,467.27 | $8,543.52 | $13,257.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,800.00 / $3,800.00 / $3,800.00
| Facility | | $3,800.00 | $3,800.00 | $3,800.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $554.27 / $742.20 / $2,100.00
| Facility | | $554.27 | $742.20 | $2,100.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $639.00 / $5,971.00 / $8,422.00
| Facility | | $639.00 | $5,971.00 | $8,422.00 |