- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,747.54 / $1,925.96 / $4,846.00
| Facility | | $1,747.54 | $1,925.96 | $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
- $1,604.97 / $2,086.46 / $2,407.46
| Facility | | $1,604.97 | $2,086.46 | $2,407.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $761.00 / $761.00 / $2,065.51
| Facility | | $761.00 | $761.00 | $2,065.51 |
- 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 |