- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,962.06 / $2,169.50 / $4,846.00
| Facility | | $1,962.06 | $2,169.50 | $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
- $1,807.92 / $2,350.30 / $2,711.88
| Facility | | $1,807.92 | $2,350.30 | $2,711.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $761.00 / $761.00 / $2,284.78
| Facility | | $761.00 | $761.00 | $2,284.78 |
- 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 |