- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,652.75 / $7,088.65 / $10,492.00
| Facility | | $2,652.75 | $7,088.65 | $10,492.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,634.00 / $12,098.00 / $17,206.00
| Facility | | $6,634.00 | $12,098.00 | $17,206.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $843.00 / $9,619.46 / $9,619.46
| Facility | | $843.00 | $9,619.46 | $9,619.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,588.00 / $4,682.00 / $5,292.53
| Facility | | $4,588.00 | $4,682.00 | $5,292.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,325.00 / $7,843.00 / $11,371.00
| Facility | | $5,325.00 | $7,843.00 | $11,371.00 |