- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,398.83 / $2,398.83 / $2,754.23
| Facility | | $2,398.83 | $2,398.83 | $2,754.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $74.13 / $91.20 / $100.00
| Facility | | $74.13 | $91.20 | $100.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $141.25 / $213.80 / $17,782.79
| Facility | | $141.25 | $213.80 | $17,782.79 |
- 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
- $1,148.15 / $3,090.30 / $3,090.30
| Facility | | $1,148.15 | $3,090.30 | $3,090.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,623.41 / $5,623.41 / $5,623.41
| Facility | | $5,623.41 | $5,623.41 | $5,623.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,162.28 / $3,162.28 / $3,715.35
| Facility | | $3,162.28 | $3,162.28 | $3,715.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,630.78 / $23,988.33 / $66,069.34
| Facility | | $3,630.78 | $23,988.33 | $66,069.34 |