- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,295.74 / $2,080.96 / $8,413.00
| Facility | | $1,295.74 | $2,080.96 | $8,413.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,794.89 / $1,794.89 / $1,821.08
| Facility | | $1,794.89 | $1,794.89 | $1,821.08 |
- 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
- $1,295.74 / $1,638.14 / $2,399.23
| Facility | | $1,295.74 | $1,638.14 | $2,399.23 |
- 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 / $10,558.38 / $10,558.38
| Facility | | $55.00 | $10,558.38 | $10,558.38 |