- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $302.00 / $3,715.35 / $10,715.19
| Facility | | $302.00 | $3,715.35 | $10,715.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,000.00 / $2,818.38 / $7,943.28
| Facility | | $1,000.00 | $2,818.38 | $7,943.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $186.21 / $199.53 / $223.87
| Facility | | $186.21 | $199.53 | $223.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $165.96 / $234.42 / $21,379.62
| Facility | | $165.96 | $234.42 | $21,379.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $21,379.62 / $21,379.62 / $21,379.62
| Facility | | $21,379.62 | $21,379.62 | $21,379.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $100.00 / $100.00 / $2,187.76
| Facility | | $100.00 | $100.00 | $2,187.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,698.24 / $2,570.40 / $5,248.07
| Facility | | $1,698.24 | $2,570.40 | $5,248.07 |