- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,151.42 / $5,752.00 / $12,154.00
| Facility | | $1,151.42 | $5,752.00 | $12,154.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,088.00 / $4,247.00 / $9,663.00
| Facility | | $2,088.00 | $4,247.00 | $9,663.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,806.00 / $10,806.00 / $22,871.00
| Facility | | $10,806.00 | $10,806.00 | $22,871.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $806.48 / $1,597.61 / $26,542.00
| Facility | | $806.48 | $1,597.61 | $26,542.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,426.00 / $4,390.00 / $13,596.00
| Facility | | $2,426.00 | $4,390.00 | $13,596.00 |