- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,146.82 / $2,146.82 / $2,146.82
| Facility | | $2,146.82 | $2,146.82 | $2,146.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,084.56 / $8,705.71 / $17,080.89
| Facility | | $4,084.56 | $8,705.71 | $17,080.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,760.47 / $6,750.95 / $16,240.32
| Facility | | $4,760.47 | $6,750.95 | $16,240.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,869.92 / $6,171.98 / $12,787.65
| Facility | | $3,869.92 | $6,171.98 | $12,787.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,585.20 / $3,500.00 / $5,292.59
| Facility | | $1,585.20 | $3,500.00 | $5,292.59 |
- 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 |