- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $474.32 / $2,124.00 / $6,762.00
| Facility | | $474.32 | $2,124.00 | $6,762.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,069.23 / $3,958.31 / $7,696.71
| Facility | | $2,069.23 | $3,958.31 | $7,696.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $293.05 / $293.05 / $293.05
| Facility | | $293.05 | $293.05 | $293.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,001.65 / $2,001.65 / $2,001.65
| Facility | | $2,001.65 | $2,001.65 | $2,001.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,662.66 / $12,000.00 / $12,000.00
| Facility | | $2,662.66 | $12,000.00 | $12,000.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $340.71 / $481.78 / $928.82
| Facility | | $340.71 | $481.78 | $928.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $340.71 / $485.43 / $947.80
| Facility | | $340.71 | $485.43 | $947.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,154.00 / $3,314.00 / $7,600.00
| Facility | | $1,154.00 | $3,314.00 | $7,600.00 |