- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,956.42 / $1,956.42 / $1,956.42
| Facility | | $1,956.42 | $1,956.42 | $1,956.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,811.82 / $8,195.41 / $16,537.36
| Facility | | $3,811.82 | $8,195.41 | $16,537.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,330.08 / $6,140.59 / $14,772.02
| Facility | | $4,330.08 | $6,140.59 | $14,772.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,520.04 / $5,613.97 / $11,631.51
| Facility | | $3,520.04 | $5,613.97 | $11,631.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,821.12 / $3,455.00 / $5,396.28
| Facility | | $2,821.12 | $3,455.00 | $5,396.28 |
- 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 |