- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,271.14 / $1,271.14 / $7,176.00
| Facility | | $1,271.14 | $1,271.14 | $7,176.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,028.61 / $6,345.45 / $10,207.96
| Facility | | $3,028.61 | $6,345.45 | $10,207.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,963.24 / $4,204.41 / $10,114.28
| Facility | | $2,963.24 | $4,204.41 | $10,114.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,410.14 / $3,843.84 / $7,964.00
| Facility | | $2,410.14 | $3,843.84 | $7,964.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,390.43 / $2,248.03 / $5,499.18
| Facility | | $1,390.43 | $2,248.03 | $5,499.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,735.00 / $4,974.00 / $8,812.00
| Facility | | $2,735.00 | $4,974.00 | $8,812.00 |