- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $785.80 / $785.80 / $6,781.00
| Facility | | $785.80 | $785.80 | $6,781.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,850.41 / $10,038.57 / $20,505.30
| Facility | | $3,850.41 | $10,038.57 | $20,505.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,989.43 / $2,821.26 / $6,786.91
| Facility | | $1,989.43 | $2,821.26 | $6,786.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,617.26 / $2,579.30 / $5,344.03
| Facility | | $1,617.26 | $2,579.30 | $5,344.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,110.22 / $1,646.19 / $12,002.00
| Facility | | $1,110.22 | $1,646.19 | $12,002.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,577.00 / $10,743.00 / $12,774.00
| Facility | | $5,577.00 | $10,743.00 | $12,774.00 |