- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,388.11 / $1,388.11 / $1,388.11
| Facility | | $1,388.11 | $1,388.11 | $1,388.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,692.86 / $7,737.18 / $12,451.31
| Facility | | $3,692.86 | $7,737.18 | $12,451.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,224.19 / $4,572.30 / $10,999.28
| Facility | | $3,224.19 | $4,572.30 | $10,999.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,621.03 / $4,180.18 / $8,660.85
| Facility | | $2,621.03 | $4,180.18 | $8,660.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,793.17 / $2,345.91 / $3,597.21
| Facility | | $1,793.17 | $2,345.91 | $3,597.21 |
- 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 |