- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,510.86 / $1,510.86 / $4,828.00
| Facility | | $1,510.86 | $1,510.86 | $4,828.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,814.55 / $13,499.21 / $26,448.94
| Facility | | $6,814.55 | $13,499.21 | $26,448.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,661.12 / $5,194.60 / $12,496.31
| Facility | | $3,661.12 | $5,194.60 | $12,496.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,328.29 / $4,749.10 / $9,839.61
| Facility | | $3,328.29 | $4,749.10 | $9,839.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,322.27 / $2,556.05 / $5,331.00
| Facility | | $1,322.27 | $2,556.05 | $5,331.00 |
- 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 |