- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,047.05 / $1,047.05 / $1,047.05
| Facility | | $1,047.05 | $1,047.05 | $1,047.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,511.39 / $7,386.49 / $15,666.42
| Facility | | $4,511.39 | $7,386.49 | $15,666.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,800.53 / $3,971.50 / $9,553.96
| Facility | | $2,800.53 | $3,971.50 | $9,553.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,276.63 / $3,630.90 / $7,522.81
| Facility | | $2,276.63 | $3,630.90 | $7,522.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,723.68 / $2,097.00 / $3,567.57
| Facility | | $1,723.68 | $2,097.00 | $3,567.57 |
- 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 |