- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $964.62 / $7,838.38 / $8,763.29
| Facility | | $964.62 | $7,838.38 | $8,763.29 |
- 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
- $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
- $700.56 / $975.53 / $2,000.00
| Facility | | $700.56 | $975.53 | $2,000.00 |
- 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 |