- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,545.00 / $5,463.36 / $13,841.56
| Facility | | $1,545.00 | $5,463.36 | $13,841.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,833.84 / $6,306.95 / $12,298.09
| Facility | | $4,833.84 | $6,306.95 | $12,298.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,380.56 / $2,380.56 / $2,380.56
| Facility | | $2,380.56 | $2,380.56 | $2,380.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $733.67 / $1,388.25 / $8,816.00
| Facility | | $733.67 | $1,388.25 | $8,816.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $775.06 / $1,927.80 / $3,015.38
| Facility | | $775.06 | $1,927.80 | $3,015.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,694.25 / $5,582.35 / $8,632.00
| Facility | | $4,694.25 | $5,582.35 | $8,632.00 |