- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,318.00 / $3,241.39 / $4,846.00
| Facility | | $2,318.00 | $3,241.39 | $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
- $2,701.16 / $3,511.51 / $4,051.74
| Facility | | $2,701.16 | $3,511.51 | $4,051.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $761.00 / $761.00 / $3,499.22
| Facility | | $761.00 | $761.00 | $3,499.22 |
- 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 |