- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $812.83 / $7,079.46 / $12,022.64
| Facility | | $812.83 | $7,079.46 | $12,022.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,000.00 / $3,019.95 / $7,943.28
| Facility | | $1,000.00 | $3,019.95 | $7,943.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $457.09 / $512.86 / $1,737.80
| Facility | | $457.09 | $512.86 | $1,737.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $489.78 / $812.83 / $2,818.38
| Facility | | $489.78 | $812.83 | $2,818.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $691.83 / $812.83 / $2,818.38
| Facility | | $691.83 | $812.83 | $2,818.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $100.00 / $100.00 / $3,388.44
| Facility | | $100.00 | $100.00 | $3,388.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $794.33 / $4,168.69 / $7,244.36
| Facility | | $794.33 | $4,168.69 | $7,244.36 |