- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,336.51 / $2,336.51 / $2,336.51
| Facility | | $2,336.51 | $2,336.51 | $2,336.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,361.04 / $34,613.83 / $66,228.75
| Facility | | $11,361.04 | $34,613.83 | $66,228.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,734.55 / $8,136.49 / $19,573.43
| Facility | | $5,734.55 | $8,136.49 | $19,573.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,213.22 / $7,438.70 / $15,412.15
| Facility | | $5,213.22 | $7,438.70 | $15,412.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,411.17 / $3,784.08 / $6,455.20
| Facility | | $2,411.17 | $3,784.08 | $6,455.20 |
- 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 |