- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,246.61 / $1,246.61 / $4,828.00
| Facility | | $1,246.61 | $1,246.61 | $4,828.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,088.76 / $5,302.71 / $10,544.32
| Facility | | $2,088.76 | $5,302.71 | $10,544.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,024.70 / $4,291.60 / $10,324.04
| Facility | | $3,024.70 | $4,291.60 | $10,324.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,749.72 / $3,923.56 / $8,129.16
| Facility | | $2,749.72 | $3,923.56 | $8,129.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,279.76 / $2,166.76 / $3,667.24
| Facility | | $1,279.76 | $2,166.76 | $3,667.24 |
- 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 |