- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,318.00 / $3,610.85 / $5,085.28
| Facility | | $2,318.00 | $3,610.85 | $5,085.28 |
- 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
- $3,009.04 / $3,911.75 / $4,513.56
| Facility | | $3,009.04 | $3,911.75 | $4,513.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $761.00 / $761.00 / $3,886.94
| Facility | | $761.00 | $761.00 | $3,886.94 |
- 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 |