- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,338.00 / $2,750.30 / $8,413.00
| Facility | | $1,338.00 | $2,750.30 | $8,413.00 |
- 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
- $1,772.67 / $2,318.50 / $3,393.76
| Facility | | $1,772.67 | $2,318.50 | $3,393.76 |
- 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 / $22,662.20 / $22,662.20
| Facility | | $55.00 | $22,662.20 | $22,662.20 |