- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,170.80 / $1,170.80 / $6,575.00
| Facility | | $1,170.80 | $1,170.80 | $6,575.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,550.32 / $8,221.73 / $18,574.04
| Facility | | $2,550.32 | $8,221.73 | $18,574.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,722.48 / $3,862.80 / $9,292.49
| Facility | | $2,722.48 | $3,862.80 | $9,292.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,214.32 / $3,531.53 / $7,316.93
| Facility | | $2,214.32 | $3,531.53 | $7,316.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,199.11 / $1,980.59 / $6,740.00
| Facility | | $1,199.11 | $1,980.59 | $6,740.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,735.00 / $4,974.00 / $8,812.00
| Facility | | $2,735.00 | $4,974.00 | $8,812.00 |