- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,894.78 / $1,894.78 / $1,894.78
| Facility | | $1,894.78 | $1,894.78 | $1,894.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,466.88 / $12,364.74 / $23,333.99
| Facility | | $7,466.88 | $12,364.74 | $23,333.99 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,411.18 / $6,884.72 / $16,562.13
| Facility | | $4,411.18 | $6,884.72 | $16,562.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,822.68 / $6,282.76 / $13,041.05
| Facility | | $3,822.68 | $6,282.76 | $13,041.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,933.83 / $3,214.91 / $5,878.69
| Facility | | $1,933.83 | $3,214.91 | $5,878.69 |
- 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 |