- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,598.60 / $1,598.60 / $1,598.60
| Facility | | $1,598.60 | $1,598.60 | $1,598.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,058.00 / $6,574.70 / $13,161.80
| Facility | | $3,058.00 | $6,574.70 | $13,161.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,523.19 / $4,996.32 / $12,019.33
| Facility | | $3,523.19 | $4,996.32 | $12,019.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,864.10 / $4,567.84 / $9,464.04
| Facility | | $2,864.10 | $4,567.84 | $9,464.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,141.61 / $2,944.38 / $4,096.54
| Facility | | $2,141.61 | $2,944.38 | $4,096.54 |
- 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 |