- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,488.21 / $1,488.21 / $1,488.21
| Facility | | $1,488.21 | $1,488.21 | $1,488.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,184.29 / $8,671.32 / $13,770.22
| Facility | | $4,184.29 | $8,671.32 | $13,770.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,660.48 / $5,191.01 / $12,487.69
| Facility | | $3,660.48 | $5,191.01 | $12,487.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,975.71 / $4,745.83 / $9,832.83
| Facility | | $2,975.71 | $4,745.83 | $9,832.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,004.17 / $2,594.23 / $3,864.94
| Facility | | $2,004.17 | $2,594.23 | $3,864.94 |
- 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 |