- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,250.10 / $1,250.10 / $6,955.00
| Facility | | $1,250.10 | $1,250.10 | $6,955.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,205.80 / $5,599.85 / $10,286.48
| Facility | | $2,205.80 | $5,599.85 | $10,286.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,906.65 / $4,122.00 / $9,916.02
| Facility | | $2,906.65 | $4,122.00 | $9,916.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,362.90 / $3,768.49 / $7,807.89
| Facility | | $2,362.90 | $3,768.49 | $7,807.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,623.91 / $2,112.69 / $3,500.00
| Facility | | $1,623.91 | $2,112.69 | $3,500.00 |
- 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 |