- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,184.00 / $3,255.00 / $14,285.00
| Facility | | $1,184.00 | $3,255.00 | $14,285.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,232.00 / $5,208.00 / $15,356.00
| Facility | | $2,232.00 | $5,208.00 | $15,356.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,482.00 / $17,526.00 / $29,291.00
| Facility | | $14,482.00 | $17,526.00 | $29,291.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $216.32 / $1,420.42 / $5,187.00
| Facility | | $216.32 | $1,420.42 | $5,187.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,426.00 / $4,432.00 / $25,157.00
| Facility | | $2,426.00 | $4,432.00 | $25,157.00 |