- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,437.66 / $1,437.66 / $1,437.66
| Facility | | $1,437.66 | $1,437.66 | $1,437.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,692.86 / $7,737.18 / $12,848.79
| Facility | | $3,692.86 | $7,737.18 | $12,848.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,338.73 / $4,734.74 / $11,390.06
| Facility | | $3,338.73 | $4,734.74 | $11,390.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,714.15 / $4,328.68 / $8,968.54
| Facility | | $2,714.15 | $4,328.68 | $8,968.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,963.61 / $2,429.65 / $3,740.80
| Facility | | $1,963.61 | $2,429.65 | $3,740.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,751.00 / $3,500.00 / $8,152.00
| Facility | | $1,751.00 | $3,500.00 | $8,152.00 |