- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $691.83 / $2,818.38 / $10,715.19
| Facility | | $691.83 | $2,818.38 | $10,715.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,000.00 / $2,818.38 / $7,943.28
| Facility | | $1,000.00 | $2,818.38 | $7,943.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $389.05 / $416.87 / $467.74
| Facility | | $389.05 | $416.87 | $467.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $346.74 / $524.81 / $21,379.62
| Facility | | $346.74 | $524.81 | $21,379.62 |
- 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
- $100.00 / $100.00 / $4,365.16
| Facility | | $100.00 | $100.00 | $4,365.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,818.38 / $5,754.40 / $8,511.38
| Facility | | $2,818.38 | $5,754.40 | $8,511.38 |