- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,063.91 / $2,063.91 / $2,063.91
| Facility | | $2,063.91 | $2,063.91 | $2,063.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,509.28 / $6,665.78 / $15,917.29
| Facility | | $2,509.28 | $6,665.78 | $15,917.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,056.10 / $7,170.19 / $17,248.87
| Facility | | $5,056.10 | $7,170.19 | $17,248.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,110.25 / $6,555.28 / $13,581.79
| Facility | | $4,110.25 | $6,555.28 | $13,581.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,533.37 / $3,520.78 / $4,978.47
| Facility | | $2,533.37 | $3,520.78 | $4,978.47 |
- 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 |