- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,268.43 / $2,840.80 / $16,467.00
| Facility | | $1,268.43 | $2,840.80 | $16,467.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,005.96 / $2,005.96 / $2,005.96
| Facility | | $2,005.96 | $2,005.96 | $2,005.96 |
- 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
- $1,090.00 / $1,283.93 / $2,158.82
| Facility | | $1,090.00 | $1,283.93 | $2,158.82 |
- 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 |