- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,536.97 / $1,536.97 / $1,536.97
| Facility | | $1,536.97 | $1,536.97 | $1,536.97 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,072.46 / $6,851.76 / $13,429.82
| Facility | | $3,072.46 | $6,851.76 | $13,429.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,570.36 / $5,063.21 / $12,180.24
| Facility | | $3,570.36 | $5,063.21 | $12,180.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,902.44 / $4,628.99 / $9,590.74
| Facility | | $2,902.44 | $4,628.99 | $9,590.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,079.17 / $2,597.48 / $3,988.15
| Facility | | $2,079.17 | $2,597.48 | $3,988.15 |
- 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 |