- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,095.58 / $1,927.14 / $6,575.00
| Facility | | $1,095.58 | $1,927.14 | $6,575.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,504.43 / $10,745.13 / $21,215.50
| Facility | | $4,504.43 | $10,745.13 | $21,215.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,648.59 / $6,595.67 / $15,866.78
| Facility | | $4,648.59 | $6,595.67 | $15,866.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,780.91 / $6,030.02 / $12,493.53
| Facility | | $3,780.91 | $6,030.02 | $12,493.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,095.58 / $2,147.81 / $4,915.04
| Facility | | $1,095.58 | $2,147.81 | $4,915.04 |
- 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 |