- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,490.56 / $1,490.56 / $6,781.00
| Facility | | $1,490.56 | $1,490.56 | $6,781.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,692.86 / $7,818.61 / $13,455.94
| Facility | | $3,692.86 | $7,818.61 | $13,455.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,584.51 / $5,085.89 / $12,234.83
| Facility | | $3,584.51 | $5,085.89 | $12,234.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,258.65 / $4,649.74 / $9,633.73
| Facility | | $3,258.65 | $4,649.74 | $9,633.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,548.87 / $2,669.59 / $5,577.00
| Facility | | $1,548.87 | $2,669.59 | $5,577.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,457.00 / $9,370.00 / $12,774.00
| Facility | | $5,457.00 | $9,370.00 | $12,774.00 |