- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,522.67 / $1,522.67 / $1,522.67
| Facility | | $1,522.67 | $1,522.67 | $1,522.67 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,049.45 / $6,782.68 / $13,294.43
| Facility | | $3,049.45 | $6,782.68 | $13,294.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,539.19 / $5,019.02 / $12,073.92
| Facility | | $3,539.19 | $5,019.02 | $12,073.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,877.11 / $4,588.58 / $9,507.03
| Facility | | $2,877.11 | $4,588.58 | $9,507.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,078.79 / $2,573.31 / $3,963.14
| Facility | | $2,078.79 | $2,573.31 | $3,963.14 |
- 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 |