- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,315.78 / $6,735.00 / $15,293.79
| Facility | | $1,315.78 | $6,735.00 | $15,293.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $606.10 / $606.10 / $2,062.80
| Facility | | $606.10 | $606.10 | $2,062.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,315.79 / $1,756.29 / $2,571.14
| Facility | | $1,315.79 | $1,756.29 | $2,571.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,661.00 / $7,659.00 / $10,502.00
| Facility | | $1,661.00 | $7,659.00 | $10,502.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $10,636.64 / $10,636.64
| Facility | | $55.00 | $10,636.64 | $10,636.64 |