- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,887.86 / $1,887.86 / $6,781.00
| Facility | | $1,887.86 | $1,887.86 | $6,781.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,088.76 / $5,302.71 / $14,560.26
| Facility | | $2,088.76 | $5,302.71 | $14,560.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,568.60 / $6,482.20 / $15,593.81
| Facility | | $4,568.60 | $6,482.20 | $15,593.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,153.28 / $5,926.28 / $12,278.59
| Facility | | $4,153.28 | $5,926.28 | $12,278.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,454.07 / $3,188.43 / $5,553.63
| Facility | | $1,454.07 | $3,188.43 | $5,553.63 |
- 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 |