- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,105.33 / $2,105.33 / $2,105.33
| Facility | | $2,105.33 | $2,105.33 | $2,105.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,039.21 / $8,684.29 / $17,355.50
| Facility | | $4,039.21 | $8,684.29 | $17,355.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,661.93 / $6,611.20 / $15,904.13
| Facility | | $4,661.93 | $6,611.20 | $15,904.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,789.81 / $6,044.22 / $12,522.94
| Facility | | $3,789.81 | $6,044.22 | $12,522.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,064.77 / $3,500.00 / $5,227.47
| Facility | | $2,064.77 | $3,500.00 | $5,227.47 |
- 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 |