- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,040.00 / $8,955.84 / $8,955.84
| Facility | | $2,040.00 | $8,955.84 | $8,955.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,967.48 / $9,777.14 / $15,945.24
| Facility | | $3,967.48 | $9,777.14 | $15,945.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $732.65 / $732.65 / $732.65
| Facility | | $732.65 | $732.65 | $732.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $610.19 / $763.59 / $968.25
| Facility | | $610.19 | $763.59 | $968.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,230.00 / $9,127.00 / $10,150.00
| Facility | | $1,230.00 | $9,127.00 | $10,150.00 |