- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,757.76 / $1,757.76 / $1,757.76
| Facility | | $1,757.76 | $1,757.76 | $1,757.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,420.12 / $7,353.27 / $14,823.84
| Facility | | $3,420.12 | $7,353.27 | $14,823.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,882.84 / $5,506.35 / $13,246.26
| Facility | | $3,882.84 | $5,506.35 | $13,246.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,156.47 / $5,034.12 / $10,430.12
| Facility | | $3,156.47 | $5,034.12 | $10,430.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,499.04 / $3,053.00 / $4,792.96
| Facility | | $2,499.04 | $3,053.00 | $4,792.96 |
- 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 |