- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,164.90 / $1,164.90 / $6,781.00
| Facility | | $1,164.90 | $1,164.90 | $6,781.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,536.76 / $10,745.13 / $21,650.55
| Facility | | $5,536.76 | $10,745.13 | $21,650.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,836.13 / $4,024.05 / $9,680.40
| Facility | | $2,836.13 | $4,024.05 | $9,680.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,578.30 / $3,678.95 / $7,622.36
| Facility | | $2,578.30 | $3,678.95 | $7,622.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,207.65 / $2,031.04 / $6,470.28
| Facility | | $1,207.65 | $2,031.04 | $6,470.28 |
- 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 |