- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,301.83 / $1,301.83 / $6,781.00
| Facility | | $1,301.83 | $1,301.83 | $6,781.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,186.55 / $13,126.55 / $26,448.94
| Facility | | $6,186.55 | $13,126.55 | $26,448.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,310.08 / $4,696.52 / $11,298.11
| Facility | | $3,310.08 | $4,696.52 | $11,298.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,009.16 / $4,293.74 / $8,896.15
| Facility | | $3,009.16 | $4,293.74 | $8,896.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,409.97 / $2,371.31 / $5,913.00
| Facility | | $1,409.97 | $2,371.31 | $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 |