- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,170.48 / $2,373.71 / $4,846.00
| Facility | | $2,170.48 | $2,373.71 | $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
- $1,978.10 / $2,571.53 / $2,967.15
| Facility | | $1,978.10 | $2,571.53 | $2,967.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $761.00 / $761.00 / $2,472.91
| Facility | | $761.00 | $761.00 | $2,472.91 |
- 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 |