- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,492.39 / $1,644.29 / $4,846.00
| Facility | | $1,492.39 | $1,644.29 | $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
- $1,370.24 / $1,781.31 / $2,055.36
| Facility | | $1,370.24 | $1,781.31 | $2,055.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $761.00 / $761.00 / $1,773.55
| Facility | | $761.00 | $761.00 | $1,773.55 |
- 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 |