- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,077.33 / $6,015.00 / $11,652.00
| Facility | | $1,077.33 | $6,015.00 | $11,652.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,114.00 / $4,650.00 / $10,043.00
| Facility | | $2,114.00 | $4,650.00 | $10,043.00 |
- 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
- $666.74 / $1,370.36 / $10,160.00
| Facility | | $666.74 | $1,370.36 | $10,160.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,426.00 / $4,963.00 / $12,989.00
| Facility | | $2,426.00 | $4,963.00 | $12,989.00 |