- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,522.00 / $7,360.00 / $10,492.00
| Facility | | $3,522.00 | $7,360.00 | $10,492.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,873.00 / $9,678.00 / $12,904.00
| Facility | | $8,873.00 | $9,678.00 | $12,904.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,041.00 / $9,619.46 / $9,619.46
| Facility | | $1,041.00 | $9,619.46 | $9,619.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,302.00 / $4,390.00 / $4,645.51
| Facility | | $4,302.00 | $4,390.00 | $4,645.51 |
- 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 |