- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,354.08 / $1,354.08 / $1,354.08
| Facility | | $1,354.08 | $1,354.08 | $1,354.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,692.86 / $7,664.44 / $12,171.27
| Facility | | $3,692.86 | $7,664.44 | $12,171.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,144.17 / $4,458.83 / $10,726.31
| Facility | | $3,144.17 | $4,458.83 | $10,726.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,555.98 / $4,076.44 / $8,445.91
| Facility | | $2,555.98 | $4,076.44 | $8,445.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,658.60 / $2,288.40 / $3,500.00
| Facility | | $1,658.60 | $2,288.40 | $3,500.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,445.00 / $3,236.00 / $5,530.00
| Facility | | $1,445.00 | $3,236.00 | $5,530.00 |