- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,612.68 / $1,612.68 / $1,612.68
| Facility | | $1,612.68 | $1,612.68 | $1,612.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,228.87 / $7,203.13 / $14,118.53
| Facility | | $3,228.87 | $7,203.13 | $14,118.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,743.86 / $5,309.26 / $12,772.15
| Facility | | $3,743.86 | $5,309.26 | $12,772.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,043.49 / $4,853.93 / $10,056.81
| Facility | | $3,043.49 | $4,853.93 | $10,056.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,633.96 / $2,892.26 / $11,496.00
| Facility | | $1,633.96 | $2,892.26 | $11,496.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,028.00 / $11,496.00 / $21,528.00
| Facility | | $5,028.00 | $11,496.00 | $21,528.00 |