- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,851.57 / $1,851.57 / $1,851.57
| Facility | | $1,851.57 | $1,851.57 | $1,851.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,184.29 / $9,766.34 / $17,559.13
| Facility | | $4,184.29 | $9,766.34 | $17,559.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,565.91 / $6,475.03 / $15,576.57
| Facility | | $4,565.91 | $6,475.03 | $15,576.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,711.76 / $5,919.73 / $12,265.01
| Facility | | $3,711.76 | $5,919.73 | $12,265.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,419.13 / $3,300.68 / $4,802.46
| Facility | | $2,419.13 | $3,300.68 | $4,802.46 |
- 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 |