- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $851.12 / $7,838.38 / $8,644.27
| Facility | | $851.12 | $7,838.38 | $8,644.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,835.94 / $6,357.37 / $9,865.12
| Facility | | $1,835.94 | $6,357.37 | $9,865.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,500.00 / $4,500.00 / $4,500.00
| Facility | | $4,500.00 | $4,500.00 | $4,500.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $537.17 / $699.52 / $1,172.50
| Facility | | $537.17 | $699.52 | $1,172.50 |
- 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 |