- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,790.32 / $1,790.32 / $4,828.00
| Facility | | $1,790.32 | $1,790.32 | $4,828.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,570.82 / $3,895.97 / $14,767.05
| Facility | | $1,570.82 | $3,895.97 | $14,767.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,171.64 / $6,510.87 / $15,662.77
| Facility | | $4,171.64 | $6,510.87 | $15,662.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,615.10 / $5,941.59 / $12,332.89
| Facility | | $3,615.10 | $5,941.59 | $12,332.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,818.55 / $3,229.65 / $5,592.44
| Facility | | $1,818.55 | $3,229.65 | $5,592.44 |
- 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 |