- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $459.66 / $1,872.51 / $6,681.00
| Facility | | $459.66 | $1,872.51 | $6,681.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $888.00 / $2,066.00 / $2,805.00
| Facility | | $888.00 | $2,066.00 | $2,805.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $373.00 / $796.48 / $1,487.00
| Facility | | $373.00 | $796.48 | $1,487.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,290.34 / $1,290.34 / $12,000.00
| Facility | | $1,290.34 | $1,290.34 | $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 |