- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,658.39 / $1,658.39 / $1,658.39
| Facility | | $1,658.39 | $1,658.39 | $1,658.39 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,190.10 / $6,858.72 / $13,648.12
| Facility | | $3,190.10 | $6,858.72 | $13,648.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,673.96 / $5,210.13 / $12,533.66
| Facility | | $3,673.96 | $5,210.13 | $12,533.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,986.66 / $4,763.30 / $9,869.03
| Facility | | $2,986.66 | $4,763.30 | $9,869.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,376.67 / $3,047.13 / $4,535.26
| Facility | | $2,376.67 | $3,047.13 | $4,535.26 |
- 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 |