- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,314.20 / $1,314.20 / $7,859.00
| Facility | | $1,314.20 | $1,314.20 | $7,859.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,088.76 / $5,302.71 / $10,792.37
| Facility | | $2,088.76 | $5,302.71 | $10,792.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,239.36 / $4,596.18 / $11,056.75
| Facility | | $3,239.36 | $4,596.18 | $11,056.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,944.87 / $4,202.02 / $8,706.10
| Facility | | $2,944.87 | $4,202.02 | $8,706.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,385.33 / $2,329.87 / $4,030.05
| Facility | | $1,385.33 | $2,329.87 | $4,030.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,457.00 / $9,370.00 / $12,774.00
| Facility | | $5,457.00 | $9,370.00 | $12,774.00 |