- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $595.23 / $2,303.00 / $6,681.00
| Facility | | $595.23 | $2,303.00 | $6,681.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,852.00 / $5,269.00 / $9,272.00
| Facility | | $1,852.00 | $5,269.00 | $9,272.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $475.00 / $1,992.00 / $3,743.15
| Facility | | $475.00 | $1,992.00 | $3,743.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,731.75 / $15,338.55 / $16,394.00
| Facility | | $2,731.75 | $15,338.55 | $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 |