- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,231.00 / $2,231.00 / $2,231.00
| Facility | | $2,231.00 | $2,231.00 | $2,231.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,647.11 / $6,720.19 / $18,111.79
| Facility | | $2,647.11 | $6,720.19 | $18,111.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,624.64 / $7,976.44 / $19,188.40
| Facility | | $5,624.64 | $7,976.44 | $19,188.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,572.43 / $7,292.38 / $15,108.98
| Facility | | $4,572.43 | $7,292.38 | $15,108.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,618.89 / $3,954.00 / $5,800.19
| Facility | | $2,618.89 | $3,954.00 | $5,800.19 |
- 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 |