- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,671.00 / $4,521.00 / $9,429.00
| Facility | | $1,671.00 | $4,521.00 | $9,429.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,763.75 / $6,598.50 / $10,860.55
| Facility | | $1,763.75 | $6,598.50 | $10,860.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,019.71 / $9,019.71 / $9,019.71
| Facility | | $9,019.71 | $9,019.71 | $9,019.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $697.16 / $1,021.52 / $9,437.00
| Facility | | $697.16 | $1,021.52 | $9,437.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,315.00 / $7,341.00 / $11,396.00
| Facility | | $5,315.00 | $7,341.00 | $11,396.00 |