- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,414.32 / $1,560.05 / $4,846.00
| Facility | | $1,414.32 | $1,560.05 | $4,846.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,600.00 / $8,980.45 / $14,278.45
| Facility | | $4,600.00 | $8,980.45 | $14,278.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,300.04 / $1,690.05 / $1,950.06
| Facility | | $1,300.04 | $1,690.05 | $1,950.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $761.00 / $761.00 / $1,644.26
| Facility | | $761.00 | $761.00 | $1,644.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $612.00 / $5,076.00 / $10,396.00
| Facility | | $612.00 | $5,076.00 | $10,396.00 |