- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,764.28 / $1,764.28 / $1,764.28
| Facility | | $1,764.28 | $1,764.28 | $1,764.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,368.21 / $7,241.64 / $14,417.63
| Facility | | $3,368.21 | $7,241.64 | $14,417.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,878.63 / $5,500.37 / $13,231.89
| Facility | | $3,878.63 | $5,500.37 | $13,231.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,153.04 / $5,028.66 / $10,418.81
| Facility | | $3,153.04 | $5,028.66 | $10,418.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,258.32 / $3,053.00 / $4,380.70
| Facility | | $2,258.32 | $3,053.00 | $4,380.70 |
- 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 |