- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,624.04 / $1,624.04 / $1,624.04
| Facility | | $1,624.04 | $1,624.04 | $1,624.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,128.98 / $6,727.30 / $13,396.38
| Facility | | $3,128.98 | $6,727.30 | $13,396.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,586.36 / $5,085.89 / $12,234.83
| Facility | | $3,586.36 | $5,085.89 | $12,234.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,915.45 / $4,649.74 / $9,633.73
| Facility | | $2,915.45 | $4,649.74 | $9,633.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,157.42 / $2,794.26 / $4,116.00
| Facility | | $2,157.42 | $2,794.26 | $4,116.00 |
- 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 |