- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,938.80 / $1,938.80 / $1,938.80
| Facility | | $1,938.80 | $1,938.80 | $1,938.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,736.89 / $8,034.32 / $16,211.25
| Facility | | $3,736.89 | $8,034.32 | $16,211.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,280.39 / $6,070.12 / $14,602.49
| Facility | | $4,280.39 | $6,070.12 | $14,602.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,479.65 / $5,549.54 / $11,498.03
| Facility | | $3,479.65 | $5,549.54 | $11,498.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,051.00 / $3,500.00 / $5,440.33
| Facility | | $3,051.00 | $3,500.00 | $5,440.33 |
- 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 |