- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,270.29 / $2,270.29 / $11,316.00
| Facility | | $2,270.29 | $2,270.29 | $11,316.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,428.23 / $13,140.86 / $23,114.40
| Facility | | $7,428.23 | $13,140.86 | $23,114.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,012.31 / $7,108.08 / $17,099.45
| Facility | | $5,012.31 | $7,108.08 | $17,099.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,074.65 / $6,498.49 / $13,464.14
| Facility | | $4,074.65 | $6,498.49 | $13,464.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,789.87 / $3,836.79 / $6,156.96
| Facility | | $2,789.87 | $3,836.79 | $6,156.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,751.00 / $3,500.00 / $8,152.00
| Facility | | $1,751.00 | $3,500.00 | $8,152.00 |