- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,024.31 / $1,024.31 / $6,781.00
| Facility | | $1,024.31 | $1,024.31 | $6,781.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,633.91 / $9,984.76 / $21,650.55
| Facility | | $4,633.91 | $9,984.76 | $21,650.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,374.73 / $3,706.33 / $8,916.08
| Facility | | $2,374.73 | $3,706.33 | $8,916.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,057.91 / $3,382.27 / $7,020.54
| Facility | | $2,057.91 | $3,382.27 | $7,020.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $987.32 / $1,805.87 / $3,210.43
| Facility | | $987.32 | $1,805.87 | $3,210.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,960.00 / $7,872.00 / $11,531.00
| Facility | | $2,960.00 | $7,872.00 | $11,531.00 |