- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $894.32 / $5,000.27 / $7,838.38
| Facility | | $894.32 | $5,000.27 | $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
- $1,300.00 / $1,300.00 / $1,300.00
| Facility | | $1,300.00 | $1,300.00 | $1,300.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $651.03 / $928.13 / $1,300.00
| Facility | | $651.03 | $928.13 | $1,300.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,229.00 / $6,210.00 / $7,158.00
| Facility | | $1,229.00 | $6,210.00 | $7,158.00 |