- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,068.67 / $1,068.67 / $1,068.67
| Facility | | $1,068.67 | $1,068.67 | $1,068.67 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,184.29 / $6,899.45 / $13,020.23
| Facility | | $4,184.29 | $6,899.45 | $13,020.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,640.50 / $3,744.55 / $9,008.03
| Facility | | $2,640.50 | $3,744.55 | $9,008.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,146.53 / $3,423.42 / $7,092.94
| Facility | | $2,146.53 | $3,423.42 | $7,092.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,382.69 / $1,890.29 / $3,378.00
| Facility | | $1,382.69 | $1,890.29 | $3,378.00 |
- 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 |