- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,124.60 / $1,124.60 / $1,124.60
| Facility | | $1,124.60 | $1,124.60 | $1,124.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,166.47 / $7,180.78 / $13,020.23
| Facility | | $4,166.47 | $7,180.78 | $13,020.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,789.58 / $3,955.97 / $9,516.62
| Facility | | $2,789.58 | $3,955.97 | $9,516.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,267.73 / $3,616.70 / $7,493.40
| Facility | | $2,267.73 | $3,616.70 | $7,493.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,498.54 / $2,016.11 / $3,457.98
| Facility | | $1,498.54 | $2,016.11 | $3,457.98 |
- 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 |