- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,112.45 / $7,372.86 / $10,565.00
| Facility | | $1,112.45 | $7,372.86 | $10,565.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,873.00 / $11,830.00 / $15,521.00
| Facility | | $8,873.00 | $11,830.00 | $15,521.00 |
- 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
- $4,330.14 / $4,873.00 / $4,974.00
| Facility | | $4,330.14 | $4,873.00 | $4,974.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,943.00 / $10,336.00 / $17,069.00
| Facility | | $6,943.00 | $10,336.00 | $17,069.00 |