- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $761.32 / $5,000.27 / $7,838.38
| Facility | | $761.32 | $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
- $539.98 / $734.53 / $1,300.00
| Facility | | $539.98 | $734.53 | $1,300.00 |
- 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 |