- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,809.79 / $1,809.79 / $1,809.79
| Facility | | $1,809.79 | $1,809.79 | $1,809.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,530.68 / $9,886.87 / $16,508.77
| Facility | | $4,530.68 | $9,886.87 | $16,508.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,581.07 / $6,496.53 / $15,628.29
| Facility | | $4,581.07 | $6,496.53 | $15,628.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,724.08 / $5,939.39 / $12,305.74
| Facility | | $3,724.08 | $5,939.39 | $12,305.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,442.46 / $3,280.29 / $5,133.18
| Facility | | $2,442.46 | $3,280.29 | $5,133.18 |
- 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 |