- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,019.30 / $1,019.30 / $8,023.00
| Facility | | $1,019.30 | $1,019.30 | $8,023.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,572.34 / $9,984.76 / $21,650.55
| Facility | | $4,572.34 | $9,984.76 | $21,650.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,488.89 / $3,529.56 / $8,490.82
| Facility | | $2,488.89 | $3,529.56 | $8,490.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,023.29 / $3,226.86 / $6,685.69
| Facility | | $2,023.29 | $3,226.86 | $6,685.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,380.96 / $1,920.82 / $10,493.00
| Facility | | $1,380.96 | $1,920.82 | $10,493.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,445.00 / $5,379.86 / $11,165.00
| Facility | | $1,445.00 | $5,379.86 | $11,165.00 |