- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,215.11 / $1,215.11 / $9,810.00
| Facility | | $1,215.11 | $1,215.11 | $9,810.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,576.84 / $10,475.95 / $21,650.55
| Facility | | $5,576.84 | $10,475.95 | $21,650.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,011.94 / $4,271.30 / $10,275.19
| Facility | | $3,011.94 | $4,271.30 | $10,275.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,448.48 / $3,904.99 / $8,090.70
| Facility | | $2,448.48 | $3,904.99 | $8,090.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,617.17 / $2,469.86 / $10,533.00
| Facility | | $1,617.17 | $2,469.86 | $10,533.00 |
- 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 |