- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,137.96 / $2,137.96 / $5,011.87
| Facility | | $2,137.96 | $2,137.96 | $5,011.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,000.00 / $2,238.72 / $6,025.60
| Facility | | $1,000.00 | $2,238.72 | $6,025.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,754.40 / $8,128.31 / $19,054.61
| Facility | | $5,754.40 | $8,128.31 | $19,054.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,165.95 / $7,762.47 / $15,135.61
| Facility | | $6,165.95 | $7,762.47 | $15,135.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,137.96 / $3,548.13 / $5,754.40
| Facility | | $2,137.96 | $3,548.13 | $5,754.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,288.25 / $4,677.35 / $8,912.51
| Facility | | $1,288.25 | $4,677.35 | $8,912.51 |