- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,049.69 / $2,049.69 / $2,049.69
| Facility | | $2,049.69 | $2,049.69 | $2,049.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,063.11 / $9,850.09 / $17,785.75
| Facility | | $4,063.11 | $9,850.09 | $17,785.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,601.90 / $7,944.19 / $19,110.82
| Facility | | $5,601.90 | $7,944.19 | $19,110.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,553.93 / $7,262.89 / $15,047.89
| Facility | | $4,553.93 | $7,262.89 | $15,047.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,144.69 / $3,500.00 / $5,156.45
| Facility | | $2,144.69 | $3,500.00 | $5,156.45 |
- 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 |