- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,007.29 / $1,007.29 / $1,007.29
| Facility | | $1,007.29 | $1,007.29 | $1,007.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,182.50 / $9,735.20 / $21,331.89
| Facility | | $5,182.50 | $9,735.20 | $21,331.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,347.17 / $3,663.33 / $8,812.64
| Facility | | $2,347.17 | $3,663.33 | $8,812.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,034.03 / $3,343.03 / $6,939.09
| Facility | | $2,034.03 | $3,343.03 | $6,939.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,025.07 / $1,737.70 / $3,177.50
| Facility | | $1,025.07 | $1,737.70 | $3,177.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $796.00 / $3,500.00 / $8,152.00
| Facility | | $796.00 | $3,500.00 | $8,152.00 |