- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $805.77 / $2,133.00 / $6,681.00
| Facility | | $805.77 | $2,133.00 | $6,681.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,370.00 / $3,323.00 / $5,737.00
| Facility | | $1,370.00 | $3,323.00 | $5,737.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $373.00 / $1,487.00 / $2,709.27
| Facility | | $373.00 | $1,487.00 | $2,709.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,778.65 / $11,102.00 / $12,000.00
| Facility | | $2,778.65 | $11,102.00 | $12,000.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,236.00 / $4,027.00 / $7,669.00
| Facility | | $1,236.00 | $4,027.00 | $7,669.00 |