- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,714.36 / $1,714.36 / $1,714.36
| Facility | | $1,714.36 | $1,714.36 | $1,714.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,184.29 / $9,519.46 / $16,352.42
| Facility | | $4,184.29 | $9,519.46 | $16,352.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,229.01 / $5,997.26 / $14,427.22
| Facility | | $4,229.01 | $5,997.26 | $14,427.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,437.88 / $5,482.93 / $11,360.01
| Facility | | $3,437.88 | $5,482.93 | $11,360.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,271.31 / $3,062.83 / $4,509.72
| Facility | | $2,271.31 | $3,062.83 | $4,509.72 |
- 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 |