- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,781.13 / $1,781.13 / $1,781.13
| Facility | | $1,781.13 | $1,781.13 | $1,781.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,433.26 / $7,722.48 / $15,251.66
| Facility | | $3,433.26 | $7,722.48 | $15,251.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,946.01 / $5,595.93 / $13,461.76
| Facility | | $3,946.01 | $5,595.93 | $13,461.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,207.82 / $5,116.02 / $10,599.81
| Facility | | $3,207.82 | $5,116.02 | $10,599.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,816.27 / $3,500.00 / $5,083.47
| Facility | | $2,816.27 | $3,500.00 | $5,083.47 |
- 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 |