- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,653.03 / $1,653.03 / $1,653.03
| Facility | | $1,653.03 | $1,653.03 | $1,653.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,111.48 / $11,203.41 / $22,223.37
| Facility | | $7,111.48 | $11,203.41 | $22,223.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,656.27 / $5,185.04 / $12,473.32
| Facility | | $3,656.27 | $5,185.04 | $12,473.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,972.28 / $4,740.37 / $9,821.51
| Facility | | $2,972.28 | $4,740.37 | $9,821.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,274.80 / $3,026.45 / $4,371.68
| Facility | | $2,274.80 | $3,026.45 | $4,371.68 |
- 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 |