- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,241.11 / $1,924.91 / $8,413.00
| Facility | | $1,241.11 | $1,924.91 | $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
- $1,241.11 / $1,628.34 / $2,384.42
| Facility | | $1,241.11 | $1,628.34 | $2,384.42 |
- 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 / $5,950.27 / $6,817.20
| Facility | | $55.00 | $5,950.27 | $6,817.20 |