- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,996.76 / $4,261.00 / $12,174.00
| Facility | | $1,996.76 | $4,261.00 | $12,174.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,234.00 / $4,358.00 / $12,405.97
| Facility | | $2,234.00 | $4,358.00 | $12,405.97 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,530.00 / $2,530.00 / $2,530.00
| Facility | | $2,530.00 | $2,530.00 | $2,530.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,866.32 / $2,745.43 / $4,990.28
| Facility | | $1,866.32 | $2,745.43 | $4,990.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,816.00 / $3,006.00 / $4,790.00
| Facility | | $1,816.00 | $3,006.00 | $4,790.00 |