- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,522.00 / $7,372.86 / $10,492.00
| Facility | | $3,522.00 | $7,372.86 | $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 / $4,326.79 / $4,326.79
| Facility | | $1,041.00 | $4,326.79 | $4,326.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,630.93 / $4,721.00 / $4,819.00
| Facility | | $3,630.93 | $4,721.00 | $4,819.00 |
- 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 |