- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,857.17 / $1,857.17 / $1,857.17
| Facility | | $1,857.17 | $1,857.17 | $1,857.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,620.57 / $7,784.23 / $15,593.35
| Facility | | $3,620.57 | $7,784.23 | $15,593.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,124.57 / $5,849.15 / $14,070.92
| Facility | | $4,124.57 | $5,849.15 | $14,070.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,352.98 / $5,347.52 / $11,079.46
| Facility | | $3,352.98 | $5,347.52 | $11,079.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,413.85 / $3,170.12 / $4,902.51
| Facility | | $2,413.85 | $3,170.12 | $4,902.51 |
- 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 |