- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,030.45 / $2,030.45 / $2,030.45
| Facility | | $2,030.45 | $2,030.45 | $2,030.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $988.21 / $2,110.42 / $15,074.64
| Facility | | $988.21 | $2,110.42 | $15,074.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,496.01 / $6,375.89 / $15,338.08
| Facility | | $4,496.01 | $6,375.89 | $15,338.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,654.93 / $5,829.10 / $12,077.23
| Facility | | $3,654.93 | $5,829.10 | $12,077.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,149.11 / $3,431.46 / $5,038.99
| Facility | | $1,149.11 | $3,431.46 | $5,038.99 |
- 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 |