- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,265.63 / $3,265.63 / $3,265.63
| Facility | | $3,265.63 | $3,265.63 | $3,265.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,271.10 / $13,482.87 / $26,679.96
| Facility | | $6,271.10 | $13,482.87 | $26,679.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,217.36 / $10,235.11 / $24,621.95
| Facility | | $7,217.36 | $10,235.11 | $24,621.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,867.19 / $9,357.35 / $19,387.36
| Facility | | $5,867.19 | $9,357.35 | $19,387.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,053.00 / $5,162.14 / $8,152.00
| Facility | | $3,053.00 | $5,162.14 | $8,152.00 |
- 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 |