- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,862.00 / $6,797.57 / $10,492.00
| Facility | | $2,862.00 | $6,797.57 | $10,492.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,678.00 / $22,514.00 / $29,306.22
| Facility | | $9,678.00 | $22,514.00 | $29,306.22 |
- 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 / $5,515.00 / $5,627.00
| Facility | | $3,296.00 | $5,515.00 | $5,627.00 |
- 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 |