- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,002.71 / $1,002.71 / $2,525.00
| Facility | | $1,002.71 | $1,002.71 | $2,525.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,088.76 / $4,567.22 / $8,211.53
| Facility | | $2,088.76 | $4,567.22 | $8,211.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,442.15 / $3,465.06 / $8,335.66
| Facility | | $2,442.15 | $3,465.06 | $8,335.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,220.14 / $3,167.89 / $6,563.51
| Facility | | $2,220.14 | $3,167.89 | $6,563.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $937.64 / $1,694.58 / $3,000.45
| Facility | | $937.64 | $1,694.58 | $3,000.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,940.00 / $7,872.00 / $11,531.00
| Facility | | $3,940.00 | $7,872.00 | $11,531.00 |