- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,011.53 / $1,011.53 / $5,160.00
| Facility | | $1,011.53 | $1,011.53 | $5,160.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,920.66 / $6,563.86 / $12,629.62
| Facility | | $3,920.66 | $6,563.86 | $12,629.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,364.23 / $3,352.78 / $8,065.56
| Facility | | $2,364.23 | $3,352.78 | $8,065.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,921.95 / $3,065.24 / $6,350.84
| Facility | | $1,921.95 | $3,065.24 | $6,350.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,181.04 / $1,826.59 / $7,770.00
| Facility | | $1,181.04 | $1,826.59 | $7,770.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,735.00 / $4,974.00 / $8,812.00
| Facility | | $2,735.00 | $4,974.00 | $8,812.00 |