- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,690.54 / $1,690.54 / $1,690.54
| Facility | | $1,690.54 | $1,690.54 | $1,690.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,278.17 / $7,048.06 / $14,228.82
| Facility | | $3,278.17 | $7,048.06 | $14,228.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,737.97 / $5,300.90 / $12,752.04
| Facility | | $3,737.97 | $5,300.90 | $12,752.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,038.70 / $4,846.30 / $10,040.98
| Facility | | $3,038.70 | $4,846.30 | $10,040.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,366.01 / $3,053.00 / $4,519.91
| Facility | | $2,366.01 | $3,053.00 | $4,519.91 |
- 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 |