- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,455.36 / $1,455.36 / $1,455.36
| Facility | | $1,455.36 | $1,455.36 | $1,455.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,184.29 / $8,766.79 / $13,977.99
| Facility | | $4,184.29 | $8,766.79 | $13,977.99 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,593.10 / $5,095.46 / $12,257.82
| Facility | | $3,593.10 | $5,095.46 | $12,257.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,920.93 / $4,658.47 / $9,651.83
| Facility | | $2,920.93 | $4,658.47 | $9,651.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,940.99 / $2,569.25 / $3,765.82
| Facility | | $1,940.99 | $2,569.25 | $3,765.82 |
- 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 |