- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $920.91 / $1,472.78 / $10,561.00
| Facility | | $920.91 | $1,472.78 | $10,561.00 |
- 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
- $920.91 / $1,191.00 / $1,916.26
| Facility | | $920.91 | $1,191.00 | $1,916.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,248.00 / $9,541.00 / $14,589.00
| Facility | | $2,248.00 | $9,541.00 | $14,589.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $7,548.10 / $7,548.10
| Facility | | $55.00 | $7,548.10 | $7,548.10 |