- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,084.61 / $2,084.61 / $2,084.61
| Facility | | $2,084.61 | $2,084.61 | $2,084.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,166.47 / $10,182.26 / $19,127.14
| Facility | | $4,166.47 | $10,182.26 | $19,127.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,841.29 / $7,556.00 / $18,176.97
| Facility | | $4,841.29 | $7,556.00 | $18,176.97 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,195.39 / $6,895.34 / $14,312.58
| Facility | | $4,195.39 | $6,895.34 | $14,312.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,084.61 / $3,500.00 / $6,338.69
| Facility | | $2,084.61 | $3,500.00 | $6,338.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $796.00 / $3,500.00 / $8,152.00
| Facility | | $796.00 | $3,500.00 | $8,152.00 |