- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,089.71 / $1,089.71 / $1,089.71
| Facility | | $1,089.71 | $1,089.71 | $1,089.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,089.53 / $9,560.76 / $20,316.56
| Facility | | $5,089.53 | $9,560.76 | $20,316.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,409.71 / $3,417.28 / $8,220.73
| Facility | | $2,409.71 | $3,417.28 | $8,220.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,958.93 / $3,124.21 / $6,473.01
| Facility | | $1,958.93 | $3,124.21 | $6,473.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,587.82 / $1,990.47 / $3,500.00
| Facility | | $1,587.82 | $1,990.47 | $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 |