- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,489.68 / $1,489.68 / $1,489.68
| Facility | | $1,489.68 | $1,489.68 | $1,489.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,184.29 / $8,766.79 / $14,498.93
| Facility | | $4,184.29 | $8,766.79 | $14,498.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,684.06 / $5,224.46 / $12,568.14
| Facility | | $3,684.06 | $5,224.46 | $12,568.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,994.88 / $4,776.41 / $9,896.18
| Facility | | $2,994.88 | $4,776.41 | $9,896.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,950.73 / $2,657.93 / $3,869.57
| Facility | | $1,950.73 | $2,657.93 | $3,869.57 |
- 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 |