- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,728.87 / $1,728.87 / $1,728.87
| Facility | | $1,728.87 | $1,728.87 | $1,728.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,642.72 / $9,876.28 / $16,835.62
| Facility | | $4,642.72 | $9,876.28 | $16,835.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,029.30 / $6,288.70 / $15,128.32
| Facility | | $4,029.30 | $6,288.70 | $15,128.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,491.75 / $5,738.85 / $11,912.06
| Facility | | $3,491.75 | $5,738.85 | $11,912.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,836.57 / $3,090.87 / $5,397.57
| Facility | | $1,836.57 | $3,090.87 | $5,397.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $796.00 / $3,500.00 / $8,152.00
| Facility | | $796.00 | $3,500.00 | $8,152.00 |