- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,318.00 / $2,608.92 / $4,846.00
| Facility | | $2,318.00 | $2,608.92 | $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
- $2,217.58 / $2,826.33 / $3,261.15
| Facility | | $2,217.58 | $2,826.33 | $3,261.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $761.00 / $761.00 / $2,818.19
| Facility | | $761.00 | $761.00 | $2,818.19 |
- 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 |