- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,204.02 / $2,204.02 / $2,204.02
| Facility | | $2,204.02 | $2,204.02 | $2,204.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,466.88 / $13,747.86 / $23,333.99
| Facility | | $7,466.88 | $13,747.86 | $23,333.99 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,133.63 / $8,012.27 / $19,274.59
| Facility | | $5,133.63 | $8,012.27 | $19,274.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,448.75 / $7,311.72 / $15,176.85
| Facility | | $4,448.75 | $7,311.72 | $15,176.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,140.05 / $3,601.50 / $6,867.36
| Facility | | $2,140.05 | $3,601.50 | $6,867.36 |
- 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 |