- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,258.00 / $4,261.00 / $8,000.00
| Facility | | $1,258.00 | $4,261.00 | $8,000.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $862.00 / $2,251.00 / $5,470.00
| Facility | | $862.00 | $2,251.00 | $5,470.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,813.00 / $10,111.00 / $12,599.00
| Facility | | $5,813.00 | $10,111.00 | $12,599.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $506.63 / $859.28 / $19,067.25
| Facility | | $506.63 | $859.28 | $19,067.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,156.00 / $4,000.00 / $10,781.00
| Facility | | $2,156.00 | $4,000.00 | $10,781.00 |