- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,153.23 / $2,153.23 / $6,955.00
| Facility | | $2,153.23 | $2,153.23 | $6,955.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $987.96 / $2,073.48 / $6,855.68
| Facility | | $987.96 | $2,073.48 | $6,855.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,393.86 / $7,649.16 / $18,401.09
| Facility | | $5,393.86 | $7,649.16 | $18,401.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,384.82 / $6,993.17 / $14,489.05
| Facility | | $4,384.82 | $6,993.17 | $14,489.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,153.23 / $3,556.75 / $5,590.82
| Facility | | $2,153.23 | $3,556.75 | $5,590.82 |
- 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 |