- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,802.35 / $1,802.35 / $1,802.35
| Facility | | $1,802.35 | $1,802.35 | $1,802.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,184.29 / $9,547.15 / $17,082.33
| Facility | | $4,184.29 | $9,547.15 | $17,082.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,454.72 / $6,317.37 / $15,197.28
| Facility | | $4,454.72 | $6,317.37 | $15,197.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,621.38 / $5,775.59 / $11,966.36
| Facility | | $3,621.38 | $5,775.59 | $11,966.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,273.16 / $3,215.12 / $4,618.10
| Facility | | $2,273.16 | $3,215.12 | $4,618.10 |
- 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 |