- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,658.34 / $1,658.34 / $1,658.34
| Facility | | $1,658.34 | $1,658.34 | $1,658.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,184.29 / $9,362.90 / $15,678.43
| Facility | | $4,184.29 | $9,362.90 | $15,678.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,098.46 / $5,812.12 / $13,981.84
| Facility | | $4,098.46 | $5,812.12 | $13,981.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,331.75 / $5,313.67 / $11,009.33
| Facility | | $3,331.75 | $5,313.67 | $11,009.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,111.83 / $2,959.42 / $4,283.67
| Facility | | $2,111.83 | $2,959.42 | $4,283.67 |
- 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 |