- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,092.53 / $2,092.53 / $2,092.53
| Facility | | $2,092.53 | $2,092.53 | $2,092.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,466.88 / $13,219.05 / $23,333.99
| Facility | | $7,466.88 | $13,219.05 | $23,333.99 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,872.67 / $7,604.97 / $18,294.78
| Facility | | $4,872.67 | $7,604.97 | $18,294.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,222.59 / $6,940.03 / $14,405.34
| Facility | | $4,222.59 | $6,940.03 | $14,405.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,092.53 / $3,536.38 / $6,508.70
| Facility | | $2,092.53 | $3,536.38 | $6,508.70 |
- 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 |