- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,912.00 / $7,624.00 / $7,624.00
| Facility | | $5,912.00 | $7,624.00 | $7,624.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,055.40 / $2,010.51 / $6,261.30
| Facility | | $1,055.40 | $2,010.51 | $6,261.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,864.34 / $3,230.48 / $11,118.59
| Facility | | $1,864.34 | $3,230.48 | $11,118.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,804.00 / $3,804.00 / $4,537.00
| Facility | | $3,804.00 | $3,804.00 | $4,537.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,012.00 / $12,519.00 / $15,023.00
| Facility | | $7,012.00 | $12,519.00 | $15,023.00 |