- 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
- $5,578.27 / $7,559.99 / $14,192.03
| Facility | | $5,578.27 | $7,559.99 | $14,192.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $779.07 / $1,382.12 / $8,632.00
| Facility | | $779.07 | $1,382.12 | $8,632.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,341.00 / $1,861.85 / $4,791.04
| Facility | | $1,341.00 | $1,861.85 | $4,791.04 |
- 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 |