- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,874.14 / $1,874.14 / $1,874.14
| Facility | | $1,874.14 | $1,874.14 | $1,874.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,184.29 / $9,892.39 / $17,785.75
| Facility | | $4,184.29 | $9,892.39 | $17,785.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,624.03 / $6,557.45 / $15,774.83
| Facility | | $4,624.03 | $6,557.45 | $15,774.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,759.00 / $5,995.08 / $12,421.13
| Facility | | $3,759.00 | $5,995.08 | $12,421.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,457.73 / $3,338.05 / $4,876.57
| Facility | | $2,457.73 | $3,338.05 | $4,876.57 |
- 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 |