- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $263.03 / $2,630.27 / $10,715.19
| Facility | | $263.03 | $2,630.27 | $10,715.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,000.00 / $2,884.03 / $7,943.28
| Facility | | $1,000.00 | $2,884.03 | $7,943.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $141.25 / $151.36 / $169.82
| Facility | | $141.25 | $151.36 | $169.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $21,379.62 / $21,379.62 / $21,379.62
| Facility | | $21,379.62 | $21,379.62 | $21,379.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,165.95 / $6,165.95 / $21,379.62
| Facility | | $6,165.95 | $6,165.95 | $21,379.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $100.00 / $100.00 / $4,365.16
| Facility | | $100.00 | $100.00 | $4,365.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,570.40 / $4,365.16 / $7,413.10
| Facility | | $2,570.40 | $4,365.16 | $7,413.10 |