- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,141.58 / $1,141.58 / $1,141.58
| Facility | | $1,141.58 | $1,141.58 | $1,141.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,511.39 / $7,386.49 / $14,098.13
| Facility | | $4,511.39 | $7,386.49 | $14,098.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,889.81 / $4,098.10 / $9,858.54
| Facility | | $2,889.81 | $4,098.10 | $9,858.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,349.21 / $3,746.65 / $7,762.64
| Facility | | $2,349.21 | $3,746.65 | $7,762.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,612.09 / $2,069.52 / $3,500.00
| Facility | | $1,612.09 | $2,069.52 | $3,500.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,751.00 / $3,500.00 / $8,152.00
| Facility | | $1,751.00 | $3,500.00 | $8,152.00 |