- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,442.89 / $1,442.89 / $1,442.89
| Facility | | $1,442.89 | $1,442.89 | $1,442.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,184.29 / $8,278.68 / $13,806.35
| Facility | | $4,184.29 | $8,278.68 | $13,806.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,561.09 / $5,050.07 / $12,148.63
| Facility | | $3,561.09 | $5,050.07 | $12,148.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,894.91 / $4,616.97 / $9,565.85
| Facility | | $2,894.91 | $4,616.97 | $9,565.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,890.12 / $2,556.13 / $3,621.60
| Facility | | $1,890.12 | $2,556.13 | $3,621.60 |
- 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 |