- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,558.25 / $1,558.25 / $6,990.00
| Facility | | $1,558.25 | $1,558.25 | $6,990.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,024.85 / $8,285.45 / $15,635.81
| Facility | | $5,024.85 | $8,285.45 | $15,635.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,592.93 / $5,097.85 / $12,263.56
| Facility | | $3,592.93 | $5,097.85 | $12,263.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,922.30 / $4,660.66 / $9,656.35
| Facility | | $2,922.30 | $4,660.66 | $9,656.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,280.38 / $2,633.44 / $6,927.00
| Facility | | $1,280.38 | $2,633.44 | $6,927.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,293.00 / $6,652.00 / $9,810.00
| Facility | | $3,293.00 | $6,652.00 | $9,810.00 |