- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,126.64 / $2,631.07 / $12,615.00
| Facility | | $1,126.64 | $2,631.07 | $12,615.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,913.02 / $1,913.02 / $1,940.93
| Facility | | $1,913.02 | $1,913.02 | $1,940.93 |
- 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
- $1,126.64 / $1,632.22 / $2,156.86
| Facility | | $1,126.64 | $1,632.22 | $2,156.86 |
- 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 / $9,031.12 / $9,031.12
| Facility | | $55.00 | $9,031.12 | $9,031.12 |