- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $531.04 / $5,000.27 / $7,838.38
| Facility | | $531.04 | $5,000.27 | $7,838.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,642.88 / $5,688.84 / $8,827.71
| Facility | | $1,642.88 | $5,688.84 | $8,827.71 |
- 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
- $519.39 / $632.76 / $1,300.00
| Facility | | $519.39 | $632.76 | $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 |