- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $881.56 / $2,095.00 / $7,838.38
| Facility | | $881.56 | $2,095.00 | $7,838.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,066.57 / $10,618.71 / $16,477.70
| Facility | | $3,066.57 | $10,618.71 | $16,477.70 |
- 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
- $729.51 / $1,011.38 / $2,247.00
| Facility | | $729.51 | $1,011.38 | $2,247.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $899.00 / $8,842.00 / $16,897.00
| Facility | | $899.00 | $8,842.00 | $16,897.00 |