- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,023.29 / $3,715.35 / $12,882.50
| Facility | | $1,023.29 | $3,715.35 | $12,882.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,570.40 / $4,365.16 / $8,317.64
| Facility | | $2,570.40 | $4,365.16 | $8,317.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $660.69 / $660.69 / $660.69
| Facility | | $660.69 | $660.69 | $660.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,290.87 / $2,290.87 / $2,290.87
| Facility | | $2,290.87 | $2,290.87 | $2,290.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,912.51 / $33,884.42 / $33,884.42
| Facility | | $8,912.51 | $33,884.42 | $33,884.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $776.25 / $1,513.56 / $6,760.83
| Facility | | $776.25 | $1,513.56 | $6,760.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $741.31 / $1,000.00 / $1,737.80
| Facility | | $741.31 | $1,000.00 | $1,737.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,698.24 / $5,248.07 / $10,964.78
| Facility | | $1,698.24 | $5,248.07 | $10,964.78 |