- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,422.54 / $1,422.54 / $1,422.54
| Facility | | $1,422.54 | $1,422.54 | $1,422.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,184.29 / $8,458.95 / $13,432.96
| Facility | | $4,184.29 | $8,458.95 | $13,432.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,504.66 / $4,970.04 / $11,956.11
| Facility | | $3,504.66 | $4,970.04 | $11,956.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,849.04 / $4,543.81 / $9,414.26
| Facility | | $2,849.04 | $4,543.81 | $9,414.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,907.62 / $2,502.71 / $3,588.87
| Facility | | $1,907.62 | $2,502.71 | $3,588.87 |
- 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 |