- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $966.94 / $3,744.00 / $7,278.00
| Facility | | $966.94 | $3,744.00 | $7,278.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $575.67 / $575.67 / $584.08
| Facility | | $575.67 | $575.67 | $584.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $395.75 / $395.75 / $6,397.16
| Facility | | $395.75 | $395.75 | $6,397.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $966.94 / $1,316.75 / $1,897.54
| Facility | | $966.94 | $1,316.75 | $1,897.54 |
- 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 / $18,453.00 / $21,141.45
| Facility | | $55.00 | $18,453.00 | $21,141.45 |