- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,261.03 / $1,261.03 / $1,261.03
| Facility | | $1,261.03 | $1,261.03 | $1,261.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,141.88 / $17,710.34 / $38,732.54
| Facility | | $7,141.88 | $17,710.34 | $38,732.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,694.40 / $3,821.00 / $9,191.93
| Facility | | $2,694.40 | $3,821.00 | $9,191.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,190.36 / $3,493.31 / $7,237.74
| Facility | | $2,190.36 | $3,493.31 | $7,237.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,764.23 / $2,234.73 / $3,500.00
| Facility | | $1,764.23 | $2,234.73 | $3,500.00 |
- 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 |