- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,258.00 / $4,753.00 / $10,908.00
| Facility | | $1,258.00 | $4,753.00 | $10,908.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,294.00 / $5,965.00 / $16,201.00
| Facility | | $2,294.00 | $5,965.00 | $16,201.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,813.00 / $9,841.00 / $14,444.00
| Facility | | $5,813.00 | $9,841.00 | $14,444.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $597.86 / $1,022.28 / $19,067.25
| Facility | | $597.86 | $1,022.28 | $19,067.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,285.00 / $5,937.00 / $23,874.12
| Facility | | $2,285.00 | $5,937.00 | $23,874.12 |