- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,246.05 / $1,246.05 / $6,781.00
| Facility | | $1,246.05 | $1,246.05 | $6,781.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,025.89 / $10,716.90 / $21,399.32
| Facility | | $6,025.89 | $10,716.90 | $21,399.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,902.78 / $4,530.49 / $10,898.71
| Facility | | $2,902.78 | $4,530.49 | $10,898.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,515.52 / $4,134.37 / $8,581.66
| Facility | | $2,515.52 | $4,134.37 | $8,581.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,357.72 / $2,274.41 / $3,953.50
| Facility | | $1,357.72 | $2,274.41 | $3,953.50 |
- 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 |