- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,338.18 / $1,479.37 / $4,846.00
| Facility | | $1,338.18 | $1,479.37 | $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
- $1,232.81 / $1,602.65 / $1,849.22
| Facility | | $1,232.81 | $1,602.65 | $1,849.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $761.00 / $761.00 / $1,585.76
| Facility | | $761.00 | $761.00 | $1,585.76 |
- 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 |