- 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
- $8,873.00 / $17,011.00 / $26,880.01
| Facility | | $8,873.00 | $17,011.00 | $26,880.01 |
- 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
- $3,296.00 / $4,588.00 / $4,682.00
| Facility | | $3,296.00 | $4,588.00 | $4,682.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,644.00 / $8,468.00 / $13,943.00
| Facility | | $4,644.00 | $8,468.00 | $13,943.00 |