- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $339.01 / $1,976.37 / $6,681.00
| Facility | | $339.01 | $1,976.37 | $6,681.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $888.00 / $2,085.00 / $2,805.00
| Facility | | $888.00 | $2,085.00 | $2,805.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $375.00 / $796.48 / $1,487.00
| Facility | | $375.00 | $796.48 | $1,487.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $773.05 / $3,590.15 / $12,000.00
| Facility | | $773.05 | $3,590.15 | $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 |