- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,113.85 / $1,113.85 / $9,947.35
| Facility | | $1,113.85 | $1,113.85 | $9,947.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,459.82 / $10,256.15 / $21,650.55
| Facility | | $5,459.82 | $10,256.15 | $21,650.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,600.48 / $4,058.69 / $9,763.73
| Facility | | $2,600.48 | $4,058.69 | $9,763.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,253.55 / $3,703.82 / $7,687.98
| Facility | | $2,253.55 | $3,703.82 | $7,687.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,191.72 / $2,174.48 / $3,759.34
| Facility | | $1,191.72 | $2,174.48 | $3,759.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,960.00 / $7,872.00 / $11,531.00
| Facility | | $2,960.00 | $7,872.00 | $11,531.00 |