- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,784.54 / $1,784.54 / $1,784.54
| Facility | | $1,784.54 | $1,784.54 | $1,784.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,466.88 / $12,225.47 / $23,333.99
| Facility | | $7,466.88 | $12,225.47 | $23,333.99 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,157.10 / $6,488.17 / $15,608.17
| Facility | | $4,157.10 | $6,488.17 | $15,608.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,602.50 / $5,920.88 / $12,289.90
| Facility | | $3,602.50 | $5,920.88 | $12,289.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,784.54 / $3,053.00 / $5,539.36
| Facility | | $1,784.54 | $3,053.00 | $5,539.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $796.00 / $3,500.00 / $8,152.00
| Facility | | $796.00 | $3,500.00 | $8,152.00 |