- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,781.86 / $1,781.86 / $1,781.86
| Facility | | $1,781.86 | $1,781.86 | $1,781.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,428.23 / $11,700.53 / $23,114.40
| Facility | | $7,428.23 | $11,700.53 | $23,114.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,929.16 / $5,572.04 / $13,404.29
| Facility | | $3,929.16 | $5,572.04 | $13,404.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,194.13 / $5,094.18 / $10,554.56
| Facility | | $3,194.13 | $5,094.18 | $10,554.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,471.76 / $3,249.62 / $4,836.64
| Facility | | $2,471.76 | $3,249.62 | $4,836.64 |
- 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 |