- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,313.62 / $1,313.62 / $3,638.00
| Facility | | $1,313.62 | $1,313.62 | $3,638.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,045.81 / $7,950.77 / $12,643.17
| Facility | | $4,045.81 | $7,950.77 | $12,643.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,497.08 / $4,959.29 / $11,930.25
| Facility | | $3,497.08 | $4,959.29 | $11,930.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,842.87 / $4,533.97 / $9,393.90
| Facility | | $2,842.87 | $4,533.97 | $9,393.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,847.58 / $2,735.00 / $7,770.00
| Facility | | $1,847.58 | $2,735.00 | $7,770.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,735.00 / $4,974.00 / $8,812.00
| Facility | | $2,735.00 | $4,974.00 | $8,812.00 |