- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,045.84 / $1,045.84 / $4,828.00
| Facility | | $1,045.84 | $1,045.84 | $4,828.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,692.86 / $6,377.65 / $11,491.08
| Facility | | $3,692.86 | $6,377.65 | $11,491.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,544.01 / $3,609.58 / $8,683.34
| Facility | | $2,544.01 | $3,609.58 | $8,683.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,312.73 / $3,300.02 / $6,837.28
| Facility | | $2,312.73 | $3,300.02 | $6,837.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,069.15 / $1,978.62 / $4,974.00
| Facility | | $1,069.15 | $1,978.62 | $4,974.00 |
- 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 |