- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,862.00 / $6,805.10 / $9,583.00
| Facility | | $2,862.00 | $6,805.10 | $9,583.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,217.00 / $8,931.00 / $11,908.00
| Facility | | $8,217.00 | $8,931.00 | $11,908.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $843.00 / $2,296.86 / $2,296.86
| Facility | | $843.00 | $2,296.86 | $2,296.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,458.67 / $4,207.00 / $4,292.00
| Facility | | $2,458.67 | $4,207.00 | $4,292.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,614.00 / $5,307.00 / $8,879.00
| Facility | | $2,614.00 | $5,307.00 | $8,879.00 |