- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,258.71 / $1,258.71 / $2,525.00
| Facility | | $1,258.71 | $1,258.71 | $2,525.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,975.98 / $12,222.68 / $24,627.71
| Facility | | $5,975.98 | $12,222.68 | $24,627.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,090.36 / $4,384.77 / $10,548.16
| Facility | | $3,090.36 | $4,384.77 | $10,548.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,809.42 / $4,008.73 / $8,305.64
| Facility | | $2,809.42 | $4,008.73 | $8,305.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,391.00 / $2,167.87 / $7,134.54
| Facility | | $1,391.00 | $2,167.87 | $7,134.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,940.00 / $7,872.00 / $11,531.00
| Facility | | $3,940.00 | $7,872.00 | $11,531.00 |