- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,159.06 / $2,159.06 / $6,955.00
| Facility | | $2,159.06 | $2,159.06 | $6,955.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $987.96 / $2,072.14 / $3,863.32
| Facility | | $987.96 | $2,072.14 | $3,863.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,413.23 / $7,676.63 / $18,467.18
| Facility | | $5,413.23 | $7,676.63 | $18,467.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,400.57 / $7,018.28 / $14,541.09
| Facility | | $4,400.57 | $7,018.28 | $14,541.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,141.54 / $3,569.86 / $5,576.00
| Facility | | $2,141.54 | $3,569.86 | $5,576.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,735.00 / $4,974.00 / $8,812.00
| Facility | | $2,735.00 | $4,974.00 | $8,812.00 |