- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,131.00 / $8,476.00 / $16,900.00
| Facility | | $3,131.00 | $8,476.00 | $16,900.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,576.92 / $6,407.69 / $16,472.62
| Facility | | $4,576.92 | $6,407.69 | $16,472.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,432.00 / $11,432.00 / $11,432.00
| Facility | | $11,432.00 | $11,432.00 | $11,432.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $918.32 / $1,659.38 / $8,038.00
| Facility | | $918.32 | $1,659.38 | $8,038.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,269.00 / $6,170.00 / $12,989.00
| Facility | | $2,269.00 | $6,170.00 | $12,989.00 |