- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,149.07 / $2,149.07 / $2,149.07
| Facility | | $2,149.07 | $2,149.07 | $2,149.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,184.29 / $9,789.26 / $18,006.98
| Facility | | $4,184.29 | $9,789.26 | $18,006.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,989.57 / $7,075.83 / $17,021.87
| Facility | | $4,989.57 | $7,075.83 | $17,021.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,056.16 / $6,469.01 / $13,403.05
| Facility | | $4,056.16 | $6,469.01 | $13,403.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,894.15 / $3,547.10 / $4,682.95
| Facility | | $1,894.15 | $3,547.10 | $4,682.95 |
- 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 |