- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,095.97 / $1,095.97 / $6,781.00
| Facility | | $1,095.97 | $1,095.97 | $6,781.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,692.86 / $6,600.71 / $11,491.08
| Facility | | $3,692.86 | $6,600.71 | $11,491.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,663.55 / $3,779.19 / $9,091.36
| Facility | | $2,663.55 | $3,779.19 | $9,091.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,421.41 / $3,455.09 / $7,158.55
| Facility | | $2,421.41 | $3,455.09 | $7,158.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,151.22 / $2,052.00 / $4,974.00
| Facility | | $1,151.22 | $2,052.00 | $4,974.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,412.00 / $4,746.00 / $8,812.00
| Facility | | $2,412.00 | $4,746.00 | $8,812.00 |