- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,167.46 / $2,402.50 / $4,846.00
| Facility | | $2,167.46 | $2,402.50 | $4,846.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,600.00 / $11,226.46 / $15,429.17
| Facility | | $4,600.00 | $11,226.46 | $15,429.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,002.08 / $2,602.69 / $3,003.12
| Facility | | $2,002.08 | $2,602.69 | $3,003.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $761.00 / $761.00 / $2,589.94
| Facility | | $761.00 | $761.00 | $2,589.94 |
- 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 |