- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,174.24 / $1,867.21 / $10,561.00
| Facility | | $1,174.24 | $1,867.21 | $10,561.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $606.10 / $606.10 / $606.10
| Facility | | $606.10 | $606.10 | $606.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,174.24 / $1,530.09 / $2,430.02
| Facility | | $1,174.24 | $1,530.09 | $2,430.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,183.00 / $12,216.00 / $19,066.00
| Facility | | $3,183.00 | $12,216.00 | $19,066.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $10,965.92 / $10,965.92
| Facility | | $55.00 | $10,965.92 | $10,965.92 |