- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,112.08 / $1,112.08 / $1,112.08
| Facility | | $1,112.08 | $1,112.08 | $1,112.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,180.89 / $9,944.10 / $21,131.14
| Facility | | $5,180.89 | $9,944.10 | $21,131.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,460.25 / $3,488.94 / $8,393.12
| Facility | | $2,460.25 | $3,488.94 | $8,393.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,000.01 / $3,189.73 / $6,608.76
| Facility | | $2,000.01 | $3,189.73 | $6,608.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,654.97 / $2,026.85 / $3,500.00
| Facility | | $1,654.97 | $2,026.85 | $3,500.00 |
- 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 |