- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,205.14 / $8,031.00 / $15,171.00
| Facility | | $3,205.14 | $8,031.00 | $15,171.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,407.00 / $12,442.00 / $20,578.61
| Facility | | $8,407.00 | $12,442.00 | $20,578.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,644.00 / $9,619.46 / $9,619.46
| Facility | | $1,644.00 | $9,619.46 | $9,619.46 |
- 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 |