- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,014.83 / $1,014.83 / $6,781.00
| Facility | | $1,014.83 | $1,014.83 | $6,781.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,225.78 / $9,816.51 / $21,331.89
| Facility | | $5,225.78 | $9,816.51 | $21,331.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,364.01 / $3,689.61 / $8,875.86
| Facility | | $2,364.01 | $3,689.61 | $8,875.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,048.62 / $3,367.01 / $6,988.86
| Facility | | $2,048.62 | $3,367.01 | $6,988.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,036.58 / $1,812.20 / $3,221.70
| Facility | | $1,036.58 | $1,812.20 | $3,221.70 |
- 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 |