- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,259.60 / $1,259.60 / $9,768.00
| Facility | | $1,259.60 | $1,259.60 | $9,768.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,647.11 / $6,355.37 / $11,475.54
| Facility | | $2,647.11 | $6,355.37 | $11,475.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,192.18 / $4,526.91 / $10,890.09
| Facility | | $3,192.18 | $4,526.91 | $10,890.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,595.01 / $4,138.68 / $8,574.87
| Facility | | $2,595.01 | $4,138.68 | $8,574.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,811.96 / $2,283.07 / $3,616.67
| Facility | | $1,811.96 | $2,283.07 | $3,616.67 |
- 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 |