- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,548.82 / $2,884.03 / $3,890.45
| Facility | | $1,548.82 | $2,884.03 | $3,890.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $85.11 / $1,621.81 / $5,011.87
| Facility | | $85.11 | $1,621.81 | $5,011.87 |
- 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
- $1,548.82 / $1,905.46 / $3,890.45
| Facility | | $1,548.82 | $1,905.46 | $3,890.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $575.44 / $912.01 / $977.24
| Facility | | $575.44 | $912.01 | $977.24 |
- 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
- $575.44 / $912.01 / $1,000.00
| Facility | | $575.44 | $912.01 | $1,000.00 |