- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,283.63 / $1,283.63 / $4,828.00
| Facility | | $1,283.63 | $1,283.63 | $4,828.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,677.15 / $7,312.81 / $11,514.83
| Facility | | $3,677.15 | $7,312.81 | $11,514.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,113.93 / $4,418.22 / $10,628.61
| Facility | | $3,113.93 | $4,418.22 | $10,628.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,830.84 / $4,039.31 / $8,368.99
| Facility | | $2,830.84 | $4,039.31 | $8,368.99 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,338.46 / $2,412.10 / $4,746.00
| Facility | | $1,338.46 | $2,412.10 | $4,746.00 |
- 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 |