- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,945.56 / $1,945.56 / $1,945.56
| Facility | | $1,945.56 | $1,945.56 | $1,945.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,711.93 / $7,980.64 / $15,985.26
| Facility | | $3,711.93 | $7,980.64 | $15,985.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,298.92 / $6,096.40 / $14,665.71
| Facility | | $4,298.92 | $6,096.40 | $14,665.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,494.71 / $5,573.57 / $11,547.80
| Facility | | $3,494.71 | $5,573.57 | $11,547.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,413.58 / $3,378.00 / $5,326.53
| Facility | | $2,413.58 | $3,378.00 | $5,326.53 |
- 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 |