- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,506.35 / $6,508.00 / $9,583.00
| Facility | | $1,506.35 | $6,508.00 | $9,583.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,154.00 / $10,192.00 / $12,562.00
| Facility | | $8,154.00 | $10,192.00 | $12,562.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $843.00 / $2,296.86 / $2,296.86
| Facility | | $843.00 | $2,296.86 | $2,296.86 |
- 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 |