- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $261.56 / $2,678.00 / $6,446.00
| Facility | | $261.56 | $2,678.00 | $6,446.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,678.00 / $3,485.00 / $5,737.00
| Facility | | $1,678.00 | $3,485.00 | $5,737.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $500.00 / $1,759.11 / $2,530.00
| Facility | | $500.00 | $1,759.11 | $2,530.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $651.41 / $7,929.30 / $26,542.00
| Facility | | $651.41 | $7,929.30 | $26,542.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,000.00 / $3,335.00 / $6,285.00
| Facility | | $1,000.00 | $3,335.00 | $6,285.00 |