- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,862.00 / $6,653.00 / $9,637.10
| Facility | | $2,862.00 | $6,653.00 | $9,637.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,914.13 / $9,678.00 / $11,965.72
| Facility | | $7,914.13 | $9,678.00 | $11,965.72 |
- 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
- $4,565.00 / $6,647.00 / $9,973.00
| Facility | | $4,565.00 | $6,647.00 | $9,973.00 |