- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,296.73 / $1,296.73 / $6,781.00
| Facility | | $1,296.73 | $1,296.73 | $6,781.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,273.82 / $10,935.61 / $22,311.18
| Facility | | $6,273.82 | $10,935.61 | $22,311.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,026.00 / $4,722.80 / $11,361.32
| Facility | | $3,026.00 | $4,722.80 | $11,361.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,622.29 / $4,309.85 / $8,945.93
| Facility | | $2,622.29 | $4,309.85 | $8,945.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,373.73 / $2,316.87 / $4,045.25
| Facility | | $1,373.73 | $2,316.87 | $4,045.25 |
- 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 |