- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,383.46 / $1,383.46 / $1,383.46
| Facility | | $1,383.46 | $1,383.46 | $1,383.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,530.68 / $8,314.79 / $14,098.13
| Facility | | $4,530.68 | $8,314.79 | $14,098.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,503.82 / $4,968.85 / $11,953.24
| Facility | | $3,503.82 | $4,968.85 | $11,953.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,848.35 / $4,542.72 / $9,412.00
| Facility | | $2,848.35 | $4,542.72 | $9,412.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,879.12 / $2,504.21 / $3,882.54
| Facility | | $1,879.12 | $2,504.21 | $3,882.54 |
- 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 |