- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,263.59 / $1,263.59 / $6,781.00
| Facility | | $1,263.59 | $1,263.59 | $6,781.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,323.50 / $12,197.67 / $25,424.06
| Facility | | $4,323.50 | $12,197.67 | $25,424.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,113.09 / $4,417.02 / $10,625.74
| Facility | | $3,113.09 | $4,417.02 | $10,625.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,830.08 / $4,038.22 / $8,366.73
| Facility | | $2,830.08 | $4,038.22 | $8,366.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,360.55 / $2,225.11 / $5,913.00
| Facility | | $1,360.55 | $2,225.11 | $5,913.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,457.00 / $9,370.00 / $12,774.00
| Facility | | $5,457.00 | $9,370.00 | $12,774.00 |