- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,351.81 / $1,351.81 / $6,781.00
| Facility | | $1,351.81 | $1,351.81 | $6,781.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,088.76 / $5,302.71 / $10,792.37
| Facility | | $2,088.76 | $5,302.71 | $10,792.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,270.51 / $4,640.38 / $11,163.06
| Facility | | $3,270.51 | $4,640.38 | $11,163.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,973.19 / $4,242.42 / $8,789.81
| Facility | | $2,973.19 | $4,242.42 | $8,789.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,392.17 / $2,304.76 / $3,976.66
| Facility | | $1,392.17 | $2,304.76 | $3,976.66 |
- 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 |