- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,127.21 / $2,329.17 / $4,846.00
| Facility | | $2,127.21 | $2,329.17 | $4,846.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,838.00 / $16,821.03 / $25,253.12
| Facility | | $4,838.00 | $16,821.03 | $25,253.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,940.98 / $2,523.27 / $2,911.47
| Facility | | $1,940.98 | $2,523.27 | $2,911.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $761.00 / $761.00 / $2,418.19
| Facility | | $761.00 | $761.00 | $2,418.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,850.00 / $5,620.00 / $9,243.00
| Facility | | $1,850.00 | $5,620.00 | $9,243.00 |