- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,390.62 / $1,390.62 / $1,390.62
| Facility | | $1,390.62 | $1,390.62 | $1,390.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,142.55 / $7,893.60 / $12,890.36
| Facility | | $4,142.55 | $7,893.60 | $12,890.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,070.89 / $4,354.91 / $10,476.33
| Facility | | $3,070.89 | $4,354.91 | $10,476.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,496.42 / $3,981.43 / $8,249.08
| Facility | | $2,496.42 | $3,981.43 | $8,249.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,493.25 / $2,518.42 / $3,808.70
| Facility | | $1,493.25 | $2,518.42 | $3,808.70 |
- 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 |