- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $745.78 / $2,095.00 / $7,838.38
| Facility | | $745.78 | $2,095.00 | $7,838.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $455.75 / $1,671.13 / $2,723.08
| Facility | | $455.75 | $1,671.13 | $2,723.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,800.00 / $3,800.00 / $3,800.00
| Facility | | $3,800.00 | $3,800.00 | $3,800.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $612.46 / $782.84 / $1,029.00
| Facility | | $612.46 | $782.84 | $1,029.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $639.00 / $5,971.00 / $8,422.00
| Facility | | $639.00 | $5,971.00 | $8,422.00 |