- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,874.70 / $1,874.70 / $6,696.88
| Facility | | $1,874.70 | $1,874.70 | $6,696.88 |
- 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
- $4,368.33 / $6,817.84 / $16,401.22
| Facility | | $4,368.33 | $6,817.84 | $16,401.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,785.55 / $6,221.72 / $12,914.35
| Facility | | $3,785.55 | $6,221.72 | $12,914.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,947.19 / $3,168.24 / $5,818.11
| Facility | | $1,947.19 | $3,168.24 | $5,818.11 |
- 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 |