- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,490.89 / $1,490.89 / $4,828.00
| Facility | | $1,490.89 | $1,490.89 | $4,828.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,037.77 / $11,656.72 / $22,633.97
| Facility | | $7,037.77 | $11,656.72 | $22,633.97 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,471.40 / $5,417.96 / $13,033.63
| Facility | | $3,471.40 | $5,417.96 | $13,033.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,008.28 / $4,944.24 / $10,262.70
| Facility | | $3,008.28 | $4,944.24 | $10,262.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,563.65 / $2,712.62 / $4,657.10
| Facility | | $1,563.65 | $2,712.62 | $4,657.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $796.00 / $3,500.00 / $8,152.00
| Facility | | $796.00 | $3,500.00 | $8,152.00 |