- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,157.80 / $2,360.57 / $4,846.00
| Facility | | $2,157.80 | $2,360.57 | $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
- $1,967.14 / $2,557.28 / $2,950.71
| Facility | | $1,967.14 | $2,557.28 | $2,950.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $761.00 / $761.00 / $2,450.09
| Facility | | $761.00 | $761.00 | $2,450.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $612.00 / $5,076.00 / $10,396.00
| Facility | | $612.00 | $5,076.00 | $10,396.00 |