- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,645.82 / $1,645.82 / $1,645.82
| Facility | | $1,645.82 | $1,645.82 | $1,645.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,111.48 / $11,203.41 / $22,223.37
| Facility | | $7,111.48 | $11,203.41 | $22,223.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,636.90 / $5,157.57 / $12,407.23
| Facility | | $3,636.90 | $5,157.57 | $12,407.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,956.53 / $4,715.26 / $9,769.48
| Facility | | $2,956.53 | $4,715.26 | $9,769.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,143.98 / $3,008.52 / $4,332.77
| Facility | | $2,143.98 | $3,008.52 | $4,332.77 |
- 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 |