- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,613.86 / $1,613.86 / $10,647.00
| Facility | | $1,613.86 | $1,613.86 | $10,647.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,530.69 / $11,243.13 / $22,240.68
| Facility | | $5,530.69 | $11,243.13 | $22,240.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,923.27 / $5,563.68 / $13,384.18
| Facility | | $3,923.27 | $5,563.68 | $13,384.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,189.33 / $5,086.54 / $10,538.73
| Facility | | $3,189.33 | $5,086.54 | $10,538.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,188.63 / $2,792.39 / $4,830.08
| Facility | | $2,188.63 | $2,792.39 | $4,830.08 |
- 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 |