- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,102.55 / $2,678.00 / $6,681.00
| Facility | | $1,102.55 | $2,678.00 | $6,681.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,678.00 / $3,753.00 / $5,737.00
| Facility | | $1,678.00 | $3,753.00 | $5,737.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $500.00 / $1,759.11 / $3,125.00
| Facility | | $500.00 | $1,759.11 | $3,125.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,132.72 / $7,929.30 / $26,542.00
| Facility | | $3,132.72 | $7,929.30 | $26,542.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,236.00 / $4,021.00 / $7,669.00
| Facility | | $1,236.00 | $4,021.00 | $7,669.00 |