- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,137.01 / $1,137.01 / $4,828.00
| Facility | | $1,137.01 | $1,137.01 | $4,828.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,139.86 / $4,844.72 / $10,098.06
| Facility | | $2,139.86 | $4,844.72 | $10,098.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,754.47 / $3,908.19 / $9,401.68
| Facility | | $2,754.47 | $3,908.19 | $9,401.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,504.06 / $3,573.02 / $7,402.90
| Facility | | $2,504.06 | $3,573.02 | $7,402.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,179.58 / $2,138.04 / $4,746.00
| Facility | | $1,179.58 | $2,138.04 | $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 |