- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,122.83 / $1,122.83 / $7,626.00
| Facility | | $1,122.83 | $1,122.83 | $7,626.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,228.52 / $5,762.11 / $12,749.70
| Facility | | $2,228.52 | $5,762.11 | $12,749.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,810.64 / $3,985.83 / $9,588.45
| Facility | | $2,810.64 | $3,985.83 | $9,588.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,284.84 / $3,644.00 / $7,549.96
| Facility | | $2,284.84 | $3,644.00 | $7,549.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,216.98 / $1,939.55 / $6,652.00
| Facility | | $1,216.98 | $1,939.55 | $6,652.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,293.00 / $6,652.00 / $9,810.00
| Facility | | $3,293.00 | $6,652.00 | $9,810.00 |