- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $900.00 / $3,006.00 / $9,619.61
| Facility | | $900.00 | $3,006.00 | $9,619.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,678.00 / $3,485.00 / $5,774.00
| Facility | | $1,678.00 | $3,485.00 | $5,774.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $546.08 / $1,759.11 / $2,530.00
| Facility | | $546.08 | $1,759.11 | $2,530.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,704.86 / $7,929.30 / $26,542.00
| Facility | | $2,704.86 | $7,929.30 | $26,542.00 |
- 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 |