- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,905.46 / $3,235.94 / $3,890.45
| Facility | | $1,905.46 | $3,235.94 | $3,890.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $891.25 / $10,232.93 / $10,232.93
| Facility | | $891.25 | $10,232.93 | $10,232.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,235.94 / $3,235.94 / $5,754.40
| Facility | | $3,235.94 | $3,235.94 | $5,754.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $100.00 / $100.00 / $100.00
| Facility | | $100.00 | $100.00 | $100.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,905.46 / $3,235.94 / $3,890.45
| Facility | | $1,905.46 | $3,235.94 | $3,890.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $912.01 / $1,000.00 / $1,096.48
| Facility | | $912.01 | $1,000.00 | $1,096.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,235.94 / $3,235.94 / $5,754.40
| Facility | | $3,235.94 | $3,235.94 | $5,754.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $912.01 / $1,000.00 / $1,096.48
| Facility | | $912.01 | $1,000.00 | $1,096.48 |