- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,848.82 / $2,047.63 / $4,846.00
| Facility | | $1,848.82 | $2,047.63 | $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
- $1,706.36 / $2,218.27 / $2,559.54
| Facility | | $1,706.36 | $2,218.27 | $2,559.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $761.00 / $761.00 / $2,195.92
| Facility | | $761.00 | $761.00 | $2,195.92 |
- 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 |