- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,082.35 / $1,082.35 / $6,781.00
| Facility | | $1,082.35 | $1,082.35 | $6,781.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,121.59 / $10,745.13 / $21,650.55
| Facility | | $5,121.59 | $10,745.13 | $21,650.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,608.83 / $3,701.55 / $8,904.59
| Facility | | $2,608.83 | $3,701.55 | $8,904.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,371.66 / $3,384.11 / $7,011.49
| Facility | | $2,371.66 | $3,384.11 | $7,011.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,117.75 / $1,879.86 / $7,872.00
| Facility | | $1,117.75 | $1,879.86 | $7,872.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,940.00 / $7,872.00 / $11,531.00
| Facility | | $3,940.00 | $7,872.00 | $11,531.00 |