- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,718.00 / $4,419.35 / $8,031.00
| Facility | | $1,718.00 | $4,419.35 | $8,031.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,514.00 / $10,325.12 / $11,893.00
| Facility | | $9,514.00 | $10,325.12 | $11,893.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $843.00 / $843.00 / $843.00
| Facility | | $843.00 | $843.00 | $843.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,340.80 / $1,643.00 / $1,677.00
| Facility | | $1,340.80 | $1,643.00 | $1,677.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,325.00 / $7,843.00 / $11,371.00
| Facility | | $5,325.00 | $7,843.00 | $11,371.00 |