- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,828.55 / $1,828.55 / $1,828.55
| Facility | | $1,828.55 | $1,828.55 | $1,828.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,184.29 / $9,638.66 / $17,329.56
| Facility | | $4,184.29 | $9,638.66 | $17,329.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,498.53 / $6,379.48 / $15,346.70
| Facility | | $4,498.53 | $6,379.48 | $15,346.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,656.98 / $5,832.37 / $12,084.01
| Facility | | $3,656.98 | $5,832.37 | $12,084.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,406.64 / $3,260.30 / $4,750.58
| Facility | | $2,406.64 | $3,260.30 | $4,750.58 |
- 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 |