- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,539.87 / $1,539.87 / $1,539.87
| Facility | | $1,539.87 | $1,539.87 | $1,539.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,761.66 / $11,203.41 / $21,556.67
| Facility | | $6,761.66 | $11,203.41 | $21,556.67 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,403.59 / $4,826.71 / $11,611.31
| Facility | | $3,403.59 | $4,826.71 | $11,611.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,766.87 / $4,412.77 / $9,142.76
| Facility | | $2,766.87 | $4,412.77 | $9,142.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,142.50 / $2,789.30 / $4,090.98
| Facility | | $2,142.50 | $2,789.30 | $4,090.98 |
- 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 |