- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,728.74 / $1,728.74 / $1,728.74
| Facility | | $1,728.74 | $1,728.74 | $1,728.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,425.97 / $3,144.69 / $14,565.43
| Facility | | $1,425.97 | $3,144.69 | $14,565.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,025.48 / $6,282.73 / $15,113.95
| Facility | | $4,025.48 | $6,282.73 | $15,113.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,488.43 / $5,733.40 / $11,900.75
| Facility | | $3,488.43 | $5,733.40 | $11,900.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,674.87 / $2,952.04 / $5,398.02
| Facility | | $1,674.87 | $2,952.04 | $5,398.02 |
- 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 |