- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,350.17 / $1,350.17 / $7,397.00
| Facility | | $1,350.17 | $1,350.17 | $7,397.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,017.17 / $11,098.97 / $22,007.23
| Facility | | $6,017.17 | $11,098.97 | $22,007.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,135.43 / $4,893.60 / $11,772.22
| Facility | | $3,135.43 | $4,893.60 | $11,772.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,717.13 / $4,465.72 / $9,269.45
| Facility | | $2,717.13 | $4,465.72 | $9,269.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,329.10 / $2,389.94 / $4,238.88
| Facility | | $1,329.10 | $2,389.94 | $4,238.88 |
- 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 |