- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,348.36 / $1,348.36 / $7,927.00
| Facility | | $1,348.36 | $1,348.36 | $7,927.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,187.58 / $11,965.15 / $24,108.80
| Facility | | $6,187.58 | $11,965.15 | $24,108.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,209.03 / $4,550.80 / $10,947.56
| Facility | | $3,209.03 | $4,550.80 | $10,947.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,608.71 / $4,160.52 / $8,620.12
| Facility | | $2,608.71 | $4,160.52 | $8,620.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,291.84 / $2,477.42 / $7,770.00
| Facility | | $1,291.84 | $2,477.42 | $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 |