- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,400.00 / $8,046.75 / $14,345.00
| Facility | | $2,400.00 | $8,046.75 | $14,345.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,592.84 / $6,215.56 / $13,442.73
| Facility | | $4,592.84 | $6,215.56 | $13,442.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,432.00 / $11,432.00 / $11,432.00
| Facility | | $11,432.00 | $11,432.00 | $11,432.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $970.59 / $1,727.65 / $6,634.21
| Facility | | $970.59 | $1,727.65 | $6,634.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,967.00 / $4,960.00 / $11,732.00
| Facility | | $1,967.00 | $4,960.00 | $11,732.00 |