- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $519.64 / $1,245.00 / $6,953.60
| Facility | | $519.64 | $1,245.00 | $6,953.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,015.30 / $2,015.30 / $2,044.70
| Facility | | $2,015.30 | $2,015.30 | $2,044.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $395.75 / $395.75 / $2,710.28
| Facility | | $395.75 | $395.75 | $2,710.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $519.64 / $628.42 / $1,022.01
| Facility | | $519.64 | $628.42 | $1,022.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,711.00 / $7,162.00 / $10,397.00
| Facility | | $1,711.00 | $7,162.00 | $10,397.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,038.52 / $8,957.00 / $12,000.00
| Facility | | $2,038.52 | $8,957.00 | $12,000.00 |