- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,634.59 / $1,634.59 / $10,647.00
| Facility | | $1,634.59 | $1,634.59 | $10,647.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,436.70 / $10,662.63 / $20,114.68
| Facility | | $6,436.70 | $10,662.63 | $20,114.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,348.60 / $6,166.87 / $14,835.24
| Facility | | $4,348.60 | $6,166.87 | $14,835.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,535.11 / $5,638.00 / $11,681.29
| Facility | | $3,535.11 | $5,638.00 | $11,681.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,293.16 / $3,095.64 / $4,256.81
| Facility | | $2,293.16 | $3,095.64 | $4,256.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,751.00 / $3,500.00 / $8,152.00
| Facility | | $1,751.00 | $3,500.00 | $8,152.00 |