- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $580.28 / $2,095.00 / $7,838.38
| Facility | | $580.28 | $2,095.00 | $7,838.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,372.96 / $8,216.95 / $12,750.76
| Facility | | $2,372.96 | $8,216.95 | $12,750.76 |
- 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
- $584.71 / $798.88 / $2,100.00
| Facility | | $584.71 | $798.88 | $2,100.00 |
- 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 |