- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,318.00 / $2,547.34 / $4,846.00
| Facility | | $2,318.00 | $2,547.34 | $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
- $2,122.78 / $2,759.61 / $3,184.17
| Facility | | $2,122.78 | $2,759.61 | $3,184.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $761.00 / $761.00 / $2,649.47
| Facility | | $761.00 | $761.00 | $2,649.47 |
- 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 |