- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,079.08 / $1,079.08 / $6,781.00
| Facility | | $1,079.08 | $1,079.08 | $6,781.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,913.20 / $10,188.53 / $21,650.55
| Facility | | $4,913.20 | $10,188.53 | $21,650.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,675.87 / $3,794.72 / $9,128.70
| Facility | | $2,675.87 | $3,794.72 | $9,128.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,175.29 / $3,469.28 / $7,187.96
| Facility | | $2,175.29 | $3,469.28 | $7,187.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,405.56 / $2,191.04 / $10,878.00
| Facility | | $1,405.56 | $2,191.04 | $10,878.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,940.00 / $8,689.00 / $11,531.00
| Facility | | $3,940.00 | $8,689.00 | $11,531.00 |