- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $916.54 / $916.54 / $6,781.00
| Facility | | $916.54 | $916.54 | $6,781.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,225.51 / $10,188.53 / $20,811.61
| Facility | | $4,225.51 | $10,188.53 | $20,811.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,274.11 / $3,224.97 / $7,758.11
| Facility | | $2,274.11 | $3,224.97 | $7,758.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,848.69 / $2,948.40 / $6,108.75
| Facility | | $1,848.69 | $2,948.40 | $6,108.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,238.44 / $1,866.82 / $10,878.00
| Facility | | $1,238.44 | $1,866.82 | $10,878.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,483.00 / $7,011.00 / $11,165.00
| Facility | | $4,483.00 | $7,011.00 | $11,165.00 |