- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,480.50 / $6,653.00 / $9,637.10
| Facility | | $1,480.50 | $6,653.00 | $9,637.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,786.00 / $8,873.00 / $12,904.00
| Facility | | $5,786.00 | $8,873.00 | $12,904.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $843.00 / $4,326.79 / $4,326.79
| Facility | | $843.00 | $4,326.79 | $4,326.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,296.00 / $4,588.00 / $4,682.00
| Facility | | $3,296.00 | $4,588.00 | $4,682.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,565.00 / $6,647.00 / $9,973.00
| Facility | | $4,565.00 | $6,647.00 | $9,973.00 |