- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,074.00 / $4,377.39 / $8,031.00
| Facility | | $2,074.00 | $4,377.39 | $8,031.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,786.00 / $12,098.00 / $17,206.00
| Facility | | $5,786.00 | $12,098.00 | $17,206.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $843.00 / $18,174.68 / $18,174.68
| Facility | | $843.00 | $18,174.68 | $18,174.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,330.14 / $4,873.00 / $4,974.00
| Facility | | $4,330.14 | $4,873.00 | $4,974.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,644.00 / $8,468.00 / $13,943.00
| Facility | | $4,644.00 | $8,468.00 | $13,943.00 |