- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,318.00 / $2,998.00 / $4,846.00
| Facility | | $2,318.00 | $2,998.00 | $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
- $2,498.33 / $3,247.83 / $3,747.50
| Facility | | $2,498.33 | $3,247.83 | $3,747.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $761.00 / $761.00 / $3,204.37
| Facility | | $761.00 | $761.00 | $3,204.37 |
- 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 |