- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,087.44 / $1,087.44 / $6,781.00
| Facility | | $1,087.44 | $1,087.44 | $6,781.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,653.16 / $5,549.57 / $10,412.73
| Facility | | $2,653.16 | $5,549.57 | $10,412.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,016.99 / $4,278.47 / $10,292.43
| Facility | | $3,016.99 | $4,278.47 | $10,292.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,452.60 / $3,911.54 / $8,104.28
| Facility | | $2,452.60 | $3,911.54 | $8,104.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,420.24 / $2,141.04 / $3,500.00
| Facility | | $1,420.24 | $2,141.04 | $3,500.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,445.00 / $3,236.00 / $5,530.00
| Facility | | $1,445.00 | $3,236.00 | $5,530.00 |