- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,360.65 / $1,360.65 / $4,828.00
| Facility | | $1,360.65 | $1,360.65 | $4,828.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,677.15 / $7,395.74 / $12,333.88
| Facility | | $3,677.15 | $7,395.74 | $12,333.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,297.45 / $4,678.60 / $11,255.01
| Facility | | $3,297.45 | $4,678.60 | $11,255.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,997.68 / $4,277.35 / $8,862.20
| Facility | | $2,997.68 | $4,277.35 | $8,862.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,428.16 / $2,541.60 / $4,746.00
| Facility | | $1,428.16 | $2,541.60 | $4,746.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,412.00 / $4,746.00 / $8,812.00
| Facility | | $2,412.00 | $4,746.00 | $8,812.00 |