- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,462.65 / $1,462.65 / $1,462.65
| Facility | | $1,462.65 | $1,462.65 | $1,462.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,944.30 / $6,608.45 / $12,976.57
| Facility | | $2,944.30 | $6,608.45 | $12,976.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,405.27 / $4,829.10 / $11,617.06
| Facility | | $3,405.27 | $4,829.10 | $11,617.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,768.24 / $4,414.96 / $9,147.29
| Facility | | $2,768.24 | $4,414.96 | $9,147.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,903.24 / $2,625.16 / $3,954.00
| Facility | | $1,903.24 | $2,625.16 | $3,954.00 |
- 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 |