- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,481.44 / $1,481.44 / $1,481.44
| Facility | | $1,481.44 | $1,481.44 | $1,481.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,436.70 / $10,434.57 / $20,114.68
| Facility | | $6,436.70 | $10,434.57 | $20,114.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,946.85 / $5,597.12 / $13,464.64
| Facility | | $3,946.85 | $5,597.12 | $13,464.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,208.50 / $5,117.10 / $10,602.08
| Facility | | $3,208.50 | $5,117.10 | $10,602.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,007.71 / $2,801.23 / $3,785.27
| Facility | | $2,007.71 | $2,801.23 | $3,785.27 |
- 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 |