- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,383.39 / $3,160.56 / $16,467.00
| Facility | | $1,383.39 | $3,160.56 | $16,467.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,242.66 / $3,529.96 / $5,457.06
| Facility | | $3,242.66 | $3,529.96 | $5,457.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $100.00 / $560.00 / $615.00
| Facility | | $100.00 | $560.00 | $615.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,175.88 / $1,413.48 / $2,372.85
| Facility | | $1,175.88 | $1,413.48 | $2,372.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $454.00 / $6,074.00 / $8,818.00
| Facility | | $454.00 | $6,074.00 | $8,818.00 |