- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $495.93 / $2,678.00 / $6,681.00
| Facility | | $495.93 | $2,678.00 | $6,681.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,565.00 / $3,457.00 / $5,774.00
| Facility | | $1,565.00 | $3,457.00 | $5,774.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $455.00 / $2,277.00 / $3,295.83
| Facility | | $455.00 | $2,277.00 | $3,295.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,263.83 / $13,505.55 / $26,542.00
| Facility | | $1,263.83 | $13,505.55 | $26,542.00 |
- 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 |