- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,394.00 / $6,539.81 / $7,540.01
| Facility | | $5,394.00 | $6,539.81 | $7,540.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,806.63 / $11,806.63 / $11,806.63
| Facility | | $11,806.63 | $11,806.63 | $11,806.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,252.00 / $3,067.00 / $4,334.00
| Facility | | $1,252.00 | $3,067.00 | $4,334.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,798.34 / $7,637.63 / $13,108.57
| Facility | | $4,798.34 | $7,637.63 | $13,108.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,332.00 / $5,044.00 / $11,353.04
| Facility | | $2,332.00 | $5,044.00 | $11,353.04 |