- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,208.08 / $2,082.67 / $9,768.00
| Facility | | $1,208.08 | $2,082.67 | $9,768.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,009.38 / $10,745.13 / $21,650.55
| Facility | | $5,009.38 | $10,745.13 | $21,650.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,946.59 / $7,018.50 / $16,883.95
| Facility | | $4,946.59 | $7,018.50 | $16,883.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,023.30 / $6,416.59 / $13,294.45
| Facility | | $4,023.30 | $6,416.59 | $13,294.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,208.08 / $2,384.14 / $5,334.84
| Facility | | $1,208.08 | $2,384.14 | $5,334.84 |
- 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 |