- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,621.81 / $2,344.23 / $3,019.95
| Facility | | $1,621.81 | $2,344.23 | $3,019.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,513.56 / $1,513.56 / $3,090.30
| Facility | | $1,513.56 | $1,513.56 | $3,090.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $100.00 / $199.53 / $95,499.26
| Facility | | $100.00 | $199.53 | $95,499.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,165.95 / $8,128.31 / $8,912.51
| Facility | | $6,165.95 | $8,128.31 | $8,912.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,230.27 / $1,230.27 / $1,230.27
| Facility | | $1,230.27 | $1,230.27 | $1,230.27 |