- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $948.43 / $5,000.27 / $7,838.38
| Facility | | $948.43 | $5,000.27 | $7,838.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,618.55 / $8,768.64 / $14,070.34
| Facility | | $2,618.55 | $8,768.64 | $14,070.34 |
- 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
- $817.85 / $1,084.58 / $1,300.00
| Facility | | $817.85 | $1,084.58 | $1,300.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $790.00 / $7,773.00 / $13,891.00
| Facility | | $790.00 | $7,773.00 | $13,891.00 |