- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,318.00 / $3,206.59 / $4,846.00
| Facility | | $2,318.00 | $3,206.59 | $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
- $2,672.16 / $3,473.81 / $4,008.24
| Facility | | $2,672.16 | $3,473.81 | $4,008.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $761.00 / $761.00 / $3,340.46
| Facility | | $761.00 | $761.00 | $3,340.46 |
- 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 |