- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,078.01 / $1,078.01 / $6,955.00
| Facility | | $1,078.01 | $1,078.01 | $6,955.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,031.82 / $17,305.64 / $39,095.87
| Facility | | $5,031.82 | $17,305.64 | $39,095.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,379.40 / $3,374.28 / $8,117.28
| Facility | | $2,379.40 | $3,374.28 | $8,117.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,934.28 / $3,084.90 / $6,391.56
| Facility | | $1,934.28 | $3,084.90 | $6,391.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,705.70 / $1,982.30 / $3,500.00
| Facility | | $1,705.70 | $1,982.30 | $3,500.00 |
- 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 |