- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,014.51 / $1,014.51 / $6,575.00
| Facility | | $1,014.51 | $1,014.51 | $6,575.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,677.15 / $6,337.44 / $11,491.08
| Facility | | $3,677.15 | $6,337.44 | $11,491.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,455.62 / $3,484.17 / $8,381.62
| Facility | | $2,455.62 | $3,484.17 | $8,381.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,232.38 / $3,185.36 / $6,599.71
| Facility | | $2,232.38 | $3,185.36 | $6,599.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,052.50 / $1,738.91 / $3,307.00
| Facility | | $1,052.50 | $1,738.91 | $3,307.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,388.00 / $3,500.00 / $6,361.00
| Facility | | $1,388.00 | $3,500.00 | $6,361.00 |