- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,074.00 / $2,311.00 / $6,681.00
| Facility | | $1,074.00 | $2,311.00 | $6,681.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,917.00 / $5,081.00 / $9,272.00
| Facility | | $1,917.00 | $5,081.00 | $9,272.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $475.00 / $1,992.00 / $4,038.10
| Facility | | $475.00 | $1,992.00 | $4,038.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,384.62 / $16,547.20 / $16,547.20
| Facility | | $4,384.62 | $16,547.20 | $16,547.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,000.00 / $3,351.00 / $6,285.00
| Facility | | $1,000.00 | $3,351.00 | $6,285.00 |