- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,129.19 / $6,571.00 / $10,492.00
| Facility | | $2,129.19 | $6,571.00 | $10,492.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,154.00 / $12,098.00 / $16,131.00
| Facility | | $8,154.00 | $12,098.00 | $16,131.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,041.00 / $12,192.35 / $12,192.35
| Facility | | $1,041.00 | $12,192.35 | $12,192.35 |
- 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 |