- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $988.75 / $1,497.74 / $7,439.00
| Facility | | $988.75 | $1,497.74 | $7,439.00 |
- 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
- $988.75 / $1,282.52 / $2,034.68
| Facility | | $988.75 | $1,282.52 | $2,034.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,183.00 / $12,216.00 / $19,066.00
| Facility | | $3,183.00 | $12,216.00 | $19,066.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $8,061.34 / $8,061.34
| Facility | | $55.00 | $8,061.34 | $8,061.34 |