- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,030.06 / $2,030.06 / $2,030.06
| Facility | | $2,030.06 | $2,030.06 | $2,030.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,142.55 / $10,516.65 / $19,454.55
| Facility | | $4,142.55 | $10,516.65 | $19,454.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,066.22 / $7,184.53 / $17,283.34
| Facility | | $5,066.22 | $7,184.53 | $17,283.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,118.47 / $6,568.38 / $13,608.94
| Facility | | $4,118.47 | $6,568.38 | $13,608.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,707.56 / $3,610.50 / $5,352.74
| Facility | | $2,707.56 | $3,610.50 | $5,352.74 |
- 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 |