- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,303.07 / $1,303.07 / $1,303.07
| Facility | | $1,303.07 | $1,303.07 | $1,303.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,184.29 / $8,026.12 / $13,020.23
| Facility | | $4,184.29 | $8,026.12 | $13,020.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,211.55 / $4,554.38 / $10,956.18
| Facility | | $3,211.55 | $4,554.38 | $10,956.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,610.76 / $4,163.80 / $8,626.91
| Facility | | $2,610.76 | $4,163.80 | $8,626.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,747.95 / $2,323.66 / $3,743.40
| Facility | | $1,747.95 | $2,323.66 | $3,743.40 |
- 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 |