- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,141.48 / $4,908.03 / $8,031.00
| Facility | | $2,141.48 | $4,908.03 | $8,031.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,410.00 / $7,483.00 / $16,131.00
| Facility | | $5,410.00 | $7,483.00 | $16,131.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $737.00 / $9,619.46 / $9,619.46
| Facility | | $737.00 | $9,619.46 | $9,619.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,296.00 / $4,588.00 / $4,682.00
| Facility | | $3,296.00 | $4,588.00 | $4,682.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,565.00 / $6,647.00 / $9,973.00
| Facility | | $4,565.00 | $6,647.00 | $9,973.00 |