- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,046.54 / $2,368.66 / $16,467.00
| Facility | | $1,046.54 | $2,368.66 | $16,467.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,328.23 / $2,328.23 / $2,328.23
| Facility | | $2,328.23 | $2,328.23 | $2,328.23 |
- 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
- $885.00 / $1,057.73 / $1,779.12
| Facility | | $885.00 | $1,057.73 | $1,779.12 |
- 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 |