- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,450.86 / $2,450.86 / $2,450.86
| Facility | | $2,450.86 | $2,450.86 | $2,450.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,718.76 / $10,145.34 / $20,316.25
| Facility | | $4,718.76 | $10,145.34 | $20,316.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,440.18 / $7,714.86 / $18,559.13
| Facility | | $5,440.18 | $7,714.86 | $18,559.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,422.47 / $7,053.23 / $14,613.49
| Facility | | $4,422.47 | $7,053.23 | $14,613.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,554.18 / $3,900.53 / $6,088.78
| Facility | | $1,554.18 | $3,900.53 | $6,088.78 |
- 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 |