- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,477.31 / $1,477.31 / $1,477.31
| Facility | | $1,477.31 | $1,477.31 | $1,477.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,790.19 / $12,359.17 / $24,113.57
| Facility | | $6,790.19 | $12,359.17 | $24,113.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,714.38 / $5,267.46 / $12,671.58
| Facility | | $3,714.38 | $5,267.46 | $12,671.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,019.53 / $4,815.72 / $9,977.62
| Facility | | $3,019.53 | $4,815.72 | $9,977.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,751.00 / $2,665.92 / $3,954.00
| Facility | | $1,751.00 | $2,665.92 | $3,954.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,751.00 / $3,500.00 / $8,152.00
| Facility | | $1,751.00 | $3,500.00 | $8,152.00 |