- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,460.69 / $2,460.69 / $2,460.69
| Facility | | $2,460.69 | $2,460.69 | $2,460.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,707.59 / $10,121.32 / $20,227.59
| Facility | | $4,707.59 | $10,121.32 | $20,227.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,453.66 / $7,733.97 / $18,605.09
| Facility | | $5,453.66 | $7,733.97 | $18,605.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,433.43 / $7,070.70 / $14,649.69
| Facility | | $4,433.43 | $7,070.70 | $14,649.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,324.36 / $3,896.67 / $6,102.66
| Facility | | $2,324.36 | $3,896.67 | $6,102.66 |
- 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 |