- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,258.00 / $4,908.00 / $10,923.00
| Facility | | $1,258.00 | $4,908.00 | $10,923.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,294.00 / $5,617.00 / $16,201.00
| Facility | | $2,294.00 | $5,617.00 | $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
- $615.25 / $1,024.55 / $8,957.00
| Facility | | $615.25 | $1,024.55 | $8,957.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,708.00 / $3,527.00 / $7,134.00
| Facility | | $1,708.00 | $3,527.00 | $7,134.00 |