- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,836.78 / $2,034.60 / $4,846.00
| Facility | | $1,836.78 | $2,034.60 | $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
- $1,695.50 / $2,204.15 / $2,543.25
| Facility | | $1,695.50 | $2,204.15 | $2,543.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $761.00 / $761.00 / $2,193.30
| Facility | | $761.00 | $761.00 | $2,193.30 |
- 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 |