- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $268.08 / $2,095.00 / $7,838.38
| Facility | | $268.08 | $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
- $257.62 / $388.80 / $2,100.00
| Facility | | $257.62 | $388.80 | $2,100.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $200.00 / $1,084.00 / $1,401.00
| Facility | | $200.00 | $1,084.00 | $1,401.00 |