- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,128.41 / $4,375.00 / $16,467.00
| Facility | | $1,128.41 | $4,375.00 | $16,467.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $157.41 / $356.25 / $567.41
| Facility | | $157.41 | $356.25 | $567.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $890.00 / $890.00 / $1,112.59
| Facility | | $890.00 | $890.00 | $1,112.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $970.07 / $1,263.51 / $2,138.26
| Facility | | $970.07 | $1,263.51 | $2,138.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $225.00 / $1,221.00 / $3,585.00
| Facility | | $225.00 | $1,221.00 | $3,585.00 |