- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,087.00 / $7,365.00 / $14,670.00
| Facility | | $3,087.00 | $7,365.00 | $14,670.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,285.10 / $7,186.82 / $8,253.87
| Facility | | $3,285.10 | $7,186.82 | $8,253.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,160.00 / $11,160.00 / $11,160.00
| Facility | | $11,160.00 | $11,160.00 | $11,160.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $859.39 / $1,539.87 / $15,451.00
| Facility | | $859.39 | $1,539.87 | $15,451.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,798.00 / $5,134.00 / $12,224.00
| Facility | | $2,798.00 | $5,134.00 | $12,224.00 |