- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $97.87 / $1,400.00 / $5,971.00
| Facility | | $97.87 | $1,400.00 | $5,971.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $125.17 / $125.17 / $136.38
| Facility | | $125.17 | $125.17 | $136.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $120.77 / $120.77 / $120.77
| Facility | | $120.77 | $120.77 | $120.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,482.65 / $12,208.26 / $15,170.47
| Facility | | $6,482.65 | $12,208.26 | $15,170.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,914.33 / $8,914.33 / $8,914.33
| Facility | | $8,914.33 | $8,914.33 | $8,914.33 |