- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,443.68 / $1,443.68 / $1,443.68
| Facility | | $1,443.68 | $1,443.68 | $1,443.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,184.29 / $8,732.00 / $13,866.58
| Facility | | $4,184.29 | $8,732.00 | $13,866.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,543.40 / $5,024.99 / $12,088.29
| Facility | | $3,543.40 | $5,024.99 | $12,088.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,880.53 / $4,594.04 / $9,518.34
| Facility | | $2,880.53 | $4,594.04 | $9,518.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,747.76 / $2,548.71 / $4,133.04
| Facility | | $1,747.76 | $2,548.71 | $4,133.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,296.00 / $3,500.00 / $6,361.00
| Facility | | $2,296.00 | $3,500.00 | $6,361.00 |