- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,209.61 / $1,209.61 / $7,628.50
| Facility | | $1,209.61 | $1,209.61 | $7,628.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,539.96 / $6,932.26 / $15,949.15
| Facility | | $2,539.96 | $6,932.26 | $15,949.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,815.92 / $3,995.39 / $9,611.44
| Facility | | $2,815.92 | $3,995.39 | $9,611.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,290.32 / $3,652.74 / $7,568.06
| Facility | | $2,290.32 | $3,652.74 | $7,568.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,290.23 / $2,159.30 / $10,493.00
| Facility | | $1,290.23 | $2,159.30 | $10,493.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,940.00 / $8,689.00 / $11,531.00
| Facility | | $3,940.00 | $8,689.00 | $11,531.00 |