- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,019.86 / $1,019.86 / $4,828.00
| Facility | | $1,019.86 | $1,019.86 | $4,828.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,081.33 / $6,598.98 / $12,697.20
| Facility | | $4,081.33 | $6,598.98 | $12,697.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,462.35 / $3,493.72 / $8,404.62
| Facility | | $2,462.35 | $3,493.72 | $8,404.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,238.50 / $3,194.10 / $6,617.81
| Facility | | $2,238.50 | $3,194.10 | $6,617.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,006.62 / $1,723.56 / $3,679.08
| Facility | | $1,006.62 | $1,723.56 | $3,679.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,121.00 / $5,499.00 / $9,810.00
| Facility | | $3,121.00 | $5,499.00 | $9,810.00 |