- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,140.39 / $1,140.39 / $6,781.00
| Facility | | $1,140.39 | $1,140.39 | $6,781.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,281.89 / $10,188.53 / $21,650.55
| Facility | | $5,281.89 | $10,188.53 | $21,650.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,833.38 / $4,018.08 / $9,666.03
| Facility | | $2,833.38 | $4,018.08 | $9,666.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,303.33 / $3,673.49 / $7,611.05
| Facility | | $2,303.33 | $3,673.49 | $7,611.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,564.61 / $2,319.94 / $10,533.00
| Facility | | $1,564.61 | $2,319.94 | $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 |