- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,183.42 / $1,183.42 / $6,955.00
| Facility | | $1,183.42 | $1,183.42 | $6,955.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,205.80 / $5,348.03 / $9,656.64
| Facility | | $2,205.80 | $5,348.03 | $9,656.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,743.25 / $3,890.27 / $9,358.58
| Facility | | $2,743.25 | $3,890.27 | $9,358.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,230.07 / $3,556.64 / $7,368.96
| Facility | | $2,230.07 | $3,556.64 | $7,368.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,532.35 / $1,999.98 / $3,381.73
| Facility | | $1,532.35 | $1,999.98 | $3,381.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,751.00 / $3,500.00 / $8,152.00
| Facility | | $1,751.00 | $3,500.00 | $8,152.00 |