- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,142.82 / $1,142.82 / $1,142.82
| Facility | | $1,142.82 | $1,142.82 | $1,142.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,662.57 / $7,722.16 / $14,508.52
| Facility | | $4,662.57 | $7,722.16 | $14,508.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,662.48 / $4,155.43 / $9,996.46
| Facility | | $2,662.48 | $4,155.43 | $9,996.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,307.27 / $3,792.11 / $7,871.24
| Facility | | $2,307.27 | $3,792.11 | $7,871.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,228.33 / $2,309.21 / $3,889.41
| Facility | | $1,228.33 | $2,309.21 | $3,889.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,437.00 / $9,370.00 / $12,774.00
| Facility | | $3,437.00 | $9,370.00 | $12,774.00 |