- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,595.45 / $4,908.00 / $12,154.00
| Facility | | $1,595.45 | $4,908.00 | $12,154.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,114.00 / $4,762.00 / $10,671.00
| Facility | | $2,114.00 | $4,762.00 | $10,671.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,482.00 / $14,482.00 / $15,271.00
| Facility | | $14,482.00 | $14,482.00 | $15,271.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $1,943.63 / $8,869.77
| Facility | | $55.00 | $1,943.63 | $8,869.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,182.00 / $3,233.00 / $11,343.00
| Facility | | $1,182.00 | $3,233.00 | $11,343.00 |