- 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
- $9,422.00 / $12,905.00 / $17,206.00
| Facility | | $9,422.00 | $12,905.00 | $17,206.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,041.00 / $9,619.46 / $9,619.46
| Facility | | $1,041.00 | $9,619.46 | $9,619.46 |
- 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
- $4,644.00 / $8,468.00 / $16,323.00
| Facility | | $4,644.00 | $8,468.00 | $16,323.00 |