- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,528.01 / $1,528.01 / $1,528.01
| Facility | | $1,528.01 | $1,528.01 | $1,528.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,703.10 / $11,419.55 / $22,420.97
| Facility | | $6,703.10 | $11,419.55 | $22,420.97 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,376.64 / $4,788.49 / $11,519.36
| Facility | | $3,376.64 | $4,788.49 | $11,519.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,744.96 / $4,377.83 / $9,070.36
| Facility | | $2,744.96 | $4,377.83 | $9,070.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,122.65 / $2,792.44 / $4,156.18
| Facility | | $2,122.65 | $2,792.44 | $4,156.18 |
- 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 |