- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,087.00 / $3,800.20 / $5,719.27
| Facility | | $2,087.00 | $3,800.20 | $5,719.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,289.94 / $4,759.84 / $7,538.94
| Facility | | $2,289.94 | $4,759.84 | $7,538.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,291.71 / $10,583.97 / $20,478.77
| Facility | | $5,291.71 | $10,583.97 | $20,478.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,898.10 / $3,498.50 / $6,669.92
| Facility | | $1,898.10 | $3,498.50 | $6,669.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,817.00 / $4,817.00 / $4,817.00
| Facility | | $4,817.00 | $4,817.00 | $4,817.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,085.00 / $2,871.00 / $4,929.00
| Facility | | $2,085.00 | $2,871.00 | $4,929.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,661.00 / $5,526.67 / $19,460.00
| Facility | | $1,661.00 | $5,526.67 | $19,460.00 |