- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,764.84 / $1,957.44 / $4,846.00
| Facility | | $1,764.84 | $1,957.44 | $4,846.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,531.00 / $18,682.34 / $27,646.96
| Facility | | $5,531.00 | $18,682.34 | $27,646.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,631.20 / $2,120.56 / $2,446.80
| Facility | | $1,631.20 | $2,120.56 | $2,446.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $761.00 / $761.00 / $2,104.98
| Facility | | $761.00 | $761.00 | $2,104.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,300.00 / $11,955.00 / $17,649.00
| Facility | | $3,300.00 | $11,955.00 | $17,649.00 |