- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $946.66 / $5,000.27 / $7,838.38
| Facility | | $946.66 | $5,000.27 | $7,838.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,835.94 / $6,732.02 / $10,969.74
| Facility | | $1,835.94 | $6,732.02 | $10,969.74 |
- 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
- $218.13 / $651.13 / $929.48
| Facility | | $218.13 | $651.13 | $929.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,229.00 / $6,210.00 / $7,158.00
| Facility | | $1,229.00 | $6,210.00 | $7,158.00 |