- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,079.46 / $7,079.46 / $7,079.46
| Facility | | $7,079.46 | $7,079.46 | $7,079.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $72.44 / $91.20 / $100.00
| Facility | | $72.44 | $91.20 | $100.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $141.25 / $257.04 / $19,498.45
| Facility | | $141.25 | $257.04 | $19,498.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,096.48 / $1,348.96 / $1,862.09
| Facility | | $1,096.48 | $1,348.96 | $1,862.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,128.61 / $5,128.61 / $5,128.61
| Facility | | $5,128.61 | $5,128.61 | $5,128.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,584.89 / $18,620.87 / $63,095.73
| Facility | | $1,584.89 | $18,620.87 | $63,095.73 |