- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,701.20 / $1,701.20 / $1,701.20
| Facility | | $1,701.20 | $1,701.20 | $1,701.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,184.29 / $9,362.90 / $16,028.67
| Facility | | $4,184.29 | $9,362.90 | $16,028.67 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,202.89 / $5,960.23 / $14,338.14
| Facility | | $4,202.89 | $5,960.23 | $14,338.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,416.65 / $5,449.08 / $11,289.88
| Facility | | $3,416.65 | $5,449.08 | $11,289.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,206.92 / $3,028.70 / $4,376.31
| Facility | | $2,206.92 | $3,028.70 | $4,376.31 |
- 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 |