- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,230.00 / $7,119.04 / $19,276.96
| Facility | | $3,230.00 | $7,119.04 | $19,276.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,949.61 / $3,879.54 / $7,504.28
| Facility | | $2,949.61 | $3,879.54 | $7,504.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,368.73 / $2,368.73 / $2,368.73
| Facility | | $2,368.73 | $2,368.73 | $2,368.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $572.78 / $1,031.00 / $5,405.32
| Facility | | $572.78 | $1,031.00 | $5,405.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,020.00 / $1,421.29 / $2,961.89
| Facility | | $1,020.00 | $1,421.29 | $2,961.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,529.66 / $6,178.00 / $8,816.00
| Facility | | $2,529.66 | $6,178.00 | $8,816.00 |