- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,152.56 / $2,374.58 / $4,846.00
| Facility | | $2,152.56 | $2,374.58 | $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
- $1,978.82 / $2,572.46 / $2,968.23
| Facility | | $1,978.82 | $2,572.46 | $2,968.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $761.00 / $761.00 / $2,563.40
| Facility | | $761.00 | $761.00 | $2,563.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,403.00 / $5,076.00 / $10,926.00
| Facility | | $1,403.00 | $5,076.00 | $10,926.00 |