- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,254.65 / $1,254.65 / $1,254.65
| Facility | | $1,254.65 | $1,254.65 | $1,254.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,150.52 / $10,915.48 / $21,841.92
| Facility | | $6,150.52 | $10,915.48 | $21,841.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,917.32 / $4,553.18 / $10,953.31
| Facility | | $2,917.32 | $4,553.18 | $10,953.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,528.12 / $4,155.08 / $8,624.65
| Facility | | $2,528.12 | $4,155.08 | $8,624.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,240.88 / $2,154.04 / $3,970.82
| Facility | | $1,240.88 | $2,154.04 | $3,970.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,623.00 / $4,746.00 / $8,812.00
| Facility | | $1,623.00 | $4,746.00 | $8,812.00 |