- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,117.72 / $6,653.00 / $9,637.10
| Facility | | $1,117.72 | $6,653.00 | $9,637.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,873.00 / $11,778.00 / $16,185.00
| Facility | | $8,873.00 | $11,778.00 | $16,185.00 |
- 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
- $4,302.00 / $4,390.00 / $4,645.51
| Facility | | $4,302.00 | $4,390.00 | $4,645.51 |
- 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 |