- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,004.49 / $1,004.49 / $6,781.00
| Facility | | $1,004.49 | $1,004.49 | $6,781.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,088.76 / $4,765.85 / $8,623.58
| Facility | | $2,088.76 | $4,765.85 | $8,623.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,423.63 / $3,438.78 / $8,272.45
| Facility | | $2,423.63 | $3,438.78 | $8,272.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,203.30 / $3,143.87 / $6,513.74
| Facility | | $2,203.30 | $3,143.87 | $6,513.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,038.76 / $1,703.61 / $2,997.06
| Facility | | $1,038.76 | $1,703.61 | $2,997.06 |
- 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 |