- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,513.56 / $1,513.56 / $6,760.83
| Facility | | $1,513.56 | $1,513.56 | $6,760.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,630.27 / $4,365.16 / $8,511.38
| Facility | | $2,630.27 | $4,365.16 | $8,511.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,073.80 / $5,754.40 / $13,803.84
| Facility | | $4,073.80 | $5,754.40 | $13,803.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,365.16 / $5,495.41 / $10,715.19
| Facility | | $4,365.16 | $5,495.41 | $10,715.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,513.56 / $2,691.53 / $5,011.87
| Facility | | $1,513.56 | $2,691.53 | $5,011.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,884.03 / $5,248.07 / $8,912.51
| Facility | | $2,884.03 | $5,248.07 | $8,912.51 |