- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,000.00 / $8,988.84 / $11,044.00
| Facility | | $3,000.00 | $8,988.84 | $11,044.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,079.81 / $12,296.58 / $16,519.75
| Facility | | $8,079.81 | $12,296.58 | $16,519.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,651.00 / $10,976.88 / $13,052.02
| Facility | | $2,651.00 | $10,976.88 | $13,052.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,368.18 / $10,165.95 / $16,000.89
| Facility | | $8,368.18 | $10,165.95 | $16,000.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,350.00 / $5,888.00 / $12,801.61
| Facility | | $1,350.00 | $5,888.00 | $12,801.61 |