- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,098.39 / $4,098.39 / $4,098.39
| Facility | | $4,098.39 | $4,098.39 | $4,098.39 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,898.35 / $16,981.45 / $34,061.64
| Facility | | $7,898.35 | $16,981.45 | $34,061.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,081.29 / $12,878.40 / $30,980.73
| Facility | | $9,081.29 | $12,878.40 | $30,980.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,382.44 / $11,773.94 / $24,394.28
| Facility | | $7,382.44 | $11,773.94 | $24,394.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,834.41 / $6,489.54 / $9,563.23
| Facility | | $1,834.41 | $6,489.54 | $9,563.23 |
- 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 |