- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,355.04 / $1,355.04 / $1,355.04
| Facility | | $1,355.04 | $1,355.04 | $1,355.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,932.79 / $10,529.07 / $21,068.71
| Facility | | $5,932.79 | $10,529.07 | $21,068.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,917.60 / $4,137.52 / $9,953.37
| Facility | | $2,917.60 | $4,137.52 | $9,953.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,371.80 / $3,782.69 / $7,837.30
| Facility | | $2,371.80 | $3,782.69 | $7,837.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,987.72 / $2,418.75 / $3,625.00
| Facility | | $1,987.72 | $2,418.75 | $3,625.00 |
- 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 |