- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,173.29 / $1,173.29 / $6,575.00
| Facility | | $1,173.29 | $1,173.29 | $6,575.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,177.42 / $7,413.79 / $14,835.02
| Facility | | $4,177.42 | $7,413.79 | $14,835.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,708.17 / $3,842.50 / $9,243.65
| Facility | | $2,708.17 | $3,842.50 | $9,243.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,202.67 / $3,512.96 / $7,278.46
| Facility | | $2,202.67 | $3,512.96 | $7,278.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,140.61 / $1,982.86 / $6,927.00
| Facility | | $1,140.61 | $1,982.86 | $6,927.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,991.00 / $9,404.00 / $12,475.70
| Facility | | $3,991.00 | $9,404.00 | $12,475.70 |