- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $511.32 / $1,821.00 / $6,681.00
| Facility | | $511.32 | $1,821.00 | $6,681.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,488.00 / $3,395.00 / $5,737.00
| Facility | | $1,488.00 | $3,395.00 | $5,737.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $373.00 / $1,487.00 / $1,930.15
| Facility | | $373.00 | $1,487.00 | $1,930.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,819.92 / $1,819.92 / $12,000.00
| Facility | | $1,819.92 | $1,819.92 | $12,000.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $875.00 / $2,257.00 / $4,099.00
| Facility | | $875.00 | $2,257.00 | $4,099.00 |