- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $570.57 / $2,095.00 / $7,838.38
| Facility | | $570.57 | $2,095.00 | $7,838.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,965.91 / $13,992.02 / $21,712.27
| Facility | | $3,965.91 | $13,992.02 | $21,712.27 |
- 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
- $476.15 / $648.88 / $2,275.00
| Facility | | $476.15 | $648.88 | $2,275.00 |
- 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 |