- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,318.00 / $3,475.01 / $4,893.97
| Facility | | $2,318.00 | $3,475.01 | $4,893.97 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,600.00 / $11,226.46 / $15,429.17
| Facility | | $4,600.00 | $11,226.46 | $15,429.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,953.76 / $3,764.59 / $4,343.76
| Facility | | $2,953.76 | $3,764.59 | $4,343.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $761.00 / $761.00 / $3,755.88
| Facility | | $761.00 | $761.00 | $3,755.88 |
- 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 |