- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $860.68 / $1,395.15 / $7,838.38
| Facility | | $860.68 | $1,395.15 | $7,838.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,713.73 / $9,396.91 / $14,581.75
| Facility | | $2,713.73 | $9,396.91 | $14,581.75 |
- 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
- $689.88 / $909.56 / $2,100.00
| Facility | | $689.88 | $909.56 | $2,100.00 |
- 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 |