- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,548.95 / $5,194.00 / $10,492.00
| Facility | | $1,548.95 | $5,194.00 | $10,492.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,873.00 / $10,512.98 / $12,904.00
| Facility | | $8,873.00 | $10,512.98 | $12,904.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $843.00 / $843.00 / $843.00
| Facility | | $843.00 | $843.00 | $843.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,346.67 / $2,466.00 / $2,518.00
| Facility | | $2,346.67 | $2,466.00 | $2,518.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,242.00 / $4,647.00 / $9,973.00
| Facility | | $1,242.00 | $4,647.00 | $9,973.00 |