- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $363.08 / $3,715.35 / $10,715.19
| Facility | | $363.08 | $3,715.35 | $10,715.19 |
- 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
- $186.21 / $199.53 / $218.78
| Facility | | $186.21 | $199.53 | $218.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $162.18 / $245.47 / $21,379.62
| Facility | | $162.18 | $245.47 | $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 / $2,570.40
| Facility | | $100.00 | $100.00 | $2,570.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,238.72 / $4,265.80 / $7,244.36
| Facility | | $2,238.72 | $4,265.80 | $7,244.36 |