- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,318.00 / $2,572.23 / $4,846.00
| Facility | | $2,318.00 | $2,572.23 | $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
- $2,186.40 / $2,786.59 / $3,215.30
| Facility | | $2,186.40 | $2,786.59 | $3,215.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $761.00 / $761.00 / $2,670.97
| Facility | | $761.00 | $761.00 | $2,670.97 |
- 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 |