- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,238.42 / $2,004.75 / $8,413.00
| Facility | | $1,238.42 | $2,004.75 | $8,413.00 |
- 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
- $1,238.42 / $1,738.74 / $2,310.89
| Facility | | $1,238.42 | $1,738.74 | $2,310.89 |
- 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 / $15,924.26 / $15,924.26
| Facility | | $55.00 | $15,924.26 | $15,924.26 |