- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,043.97 / $1,043.97 / $6,781.00
| Facility | | $1,043.97 | $1,043.97 | $6,781.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,036.96 / $5,101.29 / $9,450.11
| Facility | | $3,036.96 | $5,101.29 | $9,450.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,409.32 / $3,418.47 / $8,223.60
| Facility | | $2,409.32 | $3,418.47 | $8,223.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,959.61 / $3,125.30 / $6,475.28
| Facility | | $1,959.61 | $3,125.30 | $6,475.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,043.97 / $1,764.31 / $5,625.11
| Facility | | $1,043.97 | $1,764.31 | $5,625.11 |
- 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 |