- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,879.87 / $1,879.87 / $1,879.87
| Facility | | $1,879.87 | $1,879.87 | $1,879.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,672.49 / $7,895.86 / $15,805.04
| Facility | | $3,672.49 | $7,895.86 | $15,805.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,178.47 / $5,925.59 / $14,254.81
| Facility | | $4,178.47 | $5,925.59 | $14,254.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,396.80 / $5,417.41 / $11,224.26
| Facility | | $3,396.80 | $5,417.41 | $11,224.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,633.02 / $3,225.10 / $5,027.57
| Facility | | $2,633.02 | $3,225.10 | $5,027.57 |
- 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 |