- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,715.73 / $1,715.73 / $1,715.73
| Facility | | $1,715.73 | $1,715.73 | $1,715.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,330.08 / $7,159.68 / $14,366.14
| Facility | | $3,330.08 | $7,159.68 | $14,366.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,795.24 / $5,382.12 / $12,947.43
| Facility | | $3,795.24 | $5,382.12 | $12,947.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,085.26 / $4,920.55 / $10,194.83
| Facility | | $3,085.26 | $4,920.55 | $10,194.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,211.28 / $3,053.00 / $4,515.27
| Facility | | $2,211.28 | $3,053.00 | $4,515.27 |
- 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 |