- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,924.46 / $1,924.46 / $1,924.46
| Facility | | $1,924.46 | $1,924.46 | $1,924.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,302.36 / $33,034.83 / $66,228.75
| Facility | | $9,302.36 | $33,034.83 | $66,228.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,743.71 / $6,730.64 / $16,191.47
| Facility | | $4,743.71 | $6,730.64 | $16,191.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,312.47 / $6,153.42 / $12,749.19
| Facility | | $4,312.47 | $6,153.42 | $12,749.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,941.49 / $3,252.34 / $5,319.33
| Facility | | $1,941.49 | $3,252.34 | $5,319.33 |
- 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 |