- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,552.21 / $1,552.21 / $1,552.21
| Facility | | $1,552.21 | $1,552.21 | $1,552.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,102.69 / $6,949.36 / $13,621.13
| Facility | | $3,102.69 | $6,949.36 | $13,621.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,593.10 / $5,095.46 / $12,257.82
| Facility | | $3,593.10 | $5,095.46 | $12,257.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,920.93 / $4,658.47 / $9,651.83
| Facility | | $2,920.93 | $4,658.47 | $9,651.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,010.74 / $2,773.44 / $4,160.16
| Facility | | $2,010.74 | $2,773.44 | $4,160.16 |
- 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 |