- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,382.00 / $8,477.27 / $19,276.96
| Facility | | $4,382.00 | $8,477.27 | $19,276.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,896.35 / $6,635.81 / $12,457.11
| Facility | | $4,896.35 | $6,635.81 | $12,457.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $384.22 / $664.72 / $8,816.00
| Facility | | $384.22 | $664.72 | $8,816.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $703.26 / $871.18 / $1,232.64
| Facility | | $703.26 | $871.18 | $1,232.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,178.00 / $7,441.00 / $8,816.00
| Facility | | $6,178.00 | $7,441.00 | $8,816.00 |