- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,047.39 / $4,828.00 / $12,575.28
| Facility | | $1,047.39 | $4,828.00 | $12,575.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,352.21 / $11,253.87 / $25,424.06
| Facility | | $2,352.21 | $11,253.87 | $25,424.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,547.38 / $3,614.36 / $8,694.83
| Facility | | $2,547.38 | $3,614.36 | $8,694.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,315.80 / $3,304.39 / $6,846.33
| Facility | | $2,315.80 | $3,304.39 | $6,846.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,133.79 / $2,033.01 / $9,370.00
| Facility | | $1,133.79 | $2,033.01 | $9,370.00 |
- 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 |