- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,274.08 / $1,274.08 / $1,274.08
| Facility | | $1,274.08 | $1,274.08 | $1,274.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,142.55 / $7,727.85 / $12,890.36
| Facility | | $4,142.55 | $7,727.85 | $12,890.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,099.53 / $4,395.52 / $10,574.02
| Facility | | $3,099.53 | $4,395.52 | $10,574.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,519.69 / $4,018.56 / $8,326.00
| Facility | | $2,519.69 | $4,018.56 | $8,326.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,629.21 / $2,191.86 / $3,500.00
| Facility | | $1,629.21 | $2,191.86 | $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 |