- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,234.08 / $1,234.08 / $4,828.00
| Facility | | $1,234.08 | $1,234.08 | $4,828.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,677.15 / $7,016.40 / $11,491.08
| Facility | | $3,677.15 | $7,016.40 | $11,491.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,966.61 / $4,209.18 / $10,125.77
| Facility | | $2,966.61 | $4,209.18 | $10,125.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,696.92 / $3,848.21 / $7,973.05
| Facility | | $2,696.92 | $3,848.21 | $7,973.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,281.27 / $2,281.62 / $4,746.00
| Facility | | $1,281.27 | $2,281.62 | $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 |