- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,615.00 / $3,705.76 / $12,615.00
| Facility | | $1,615.00 | $3,705.76 | $12,615.00 |
- 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
- $2,381.69 / $3,096.21 / $4,372.31
| Facility | | $2,381.69 | $3,096.21 | $4,372.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,015.00 / $15,545.00 / $22,780.00
| Facility | | $4,015.00 | $15,545.00 | $22,780.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $30,466.15 / $30,466.15
| Facility | | $55.00 | $30,466.15 | $30,466.15 |