- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,475.24 / $1,475.24 / $1,475.24
| Facility | | $1,475.24 | $1,475.24 | $1,475.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,692.86 / $7,839.14 / $13,264.34
| Facility | | $3,692.86 | $7,839.14 | $13,264.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,422.12 / $4,852.99 / $11,674.52
| Facility | | $3,422.12 | $4,852.99 | $11,674.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,781.94 / $4,436.80 / $9,192.54
| Facility | | $2,781.94 | $4,436.80 | $9,192.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,231.33 / $2,493.16 / $3,637.97
| Facility | | $1,231.33 | $2,493.16 | $3,637.97 |
- 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 |