- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,870.47 / $1,870.47 / $1,870.47
| Facility | | $1,870.47 | $1,870.47 | $1,870.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,184.29 / $9,967.69 / $17,921.14
| Facility | | $4,184.29 | $9,967.69 | $17,921.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,612.24 / $6,540.73 / $15,734.60
| Facility | | $4,612.24 | $6,540.73 | $15,734.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,749.42 / $5,979.79 / $12,389.45
| Facility | | $3,749.42 | $5,979.79 | $12,389.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,263.69 / $3,333.83 / $4,818.21
| Facility | | $2,263.69 | $3,333.83 | $4,818.21 |
- 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 |