- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,263.17 / $2,263.17 / $2,263.17
| Facility | | $2,263.17 | $2,263.17 | $2,263.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,509.28 / $6,665.78 / $18,119.54
| Facility | | $2,509.28 | $6,665.78 | $18,119.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,564.00 / $7,890.44 / $18,981.52
| Facility | | $5,564.00 | $7,890.44 | $18,981.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,523.13 / $7,213.75 / $14,946.08
| Facility | | $4,523.13 | $7,213.75 | $14,946.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,740.81 / $3,933.34 / $5,513.93
| Facility | | $2,740.81 | $3,933.34 | $5,513.93 |
- 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 |