- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,223.30 / $2,223.30 / $2,223.30
| Facility | | $2,223.30 | $2,223.30 | $2,223.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,559.19 / $34,194.19 / $66,228.75
| Facility | | $10,559.19 | $34,194.19 | $66,228.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,488.73 / $7,787.72 / $18,734.41
| Facility | | $5,488.73 | $7,787.72 | $18,734.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,989.76 / $7,119.84 / $14,751.50
| Facility | | $4,989.76 | $7,119.84 | $14,751.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,275.00 / $3,620.69 / $6,176.48
| Facility | | $2,275.00 | $3,620.69 | $6,176.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,720.00 / $3,500.00 / $8,152.00
| Facility | | $1,720.00 | $3,500.00 | $8,152.00 |