- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,032.23 / $1,654.35 / $12,615.00
| Facility | | $1,032.23 | $1,654.35 | $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
- $1,032.23 / $1,288.00 / $2,065.80
| Facility | | $1,032.23 | $1,288.00 | $2,065.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,183.00 / $12,216.00 / $19,066.00
| Facility | | $3,183.00 | $12,216.00 | $19,066.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $15,674.10 / $15,674.10
| Facility | | $55.00 | $15,674.10 | $15,674.10 |