- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $622.00 / $1,725.08 / $6,214.00
| Facility | | $622.00 | $1,725.08 | $6,214.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,565.00 / $3,279.00 / $5,774.00
| Facility | | $1,565.00 | $3,279.00 | $5,774.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $455.00 / $1,992.00 / $2,596.44
| Facility | | $455.00 | $1,992.00 | $2,596.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,305.31 / $10,639.60 / $16,394.00
| Facility | | $2,305.31 | $10,639.60 | $16,394.00 |
- 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 |