- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,215.22 / $1,215.22 / $2,525.00
| Facility | | $1,215.22 | $1,215.22 | $2,525.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,088.76 / $5,225.47 / $10,252.53
| Facility | | $2,088.76 | $5,225.47 | $10,252.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,941.35 / $4,173.35 / $10,039.57
| Facility | | $2,941.35 | $4,173.35 | $10,039.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,673.96 / $3,815.45 / $7,905.18
| Facility | | $2,673.96 | $3,815.45 | $7,905.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,256.01 / $2,112.39 / $3,500.00
| Facility | | $1,256.01 | $2,112.39 | $3,500.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,388.00 / $3,500.00 / $6,361.00
| Facility | | $1,388.00 | $3,500.00 | $6,361.00 |