- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,383.58 / $1,383.58 / $1,383.58
| Facility | | $1,383.58 | $1,383.58 | $1,383.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,084.44 / $10,798.22 / $21,556.67
| Facility | | $6,084.44 | $10,798.22 | $21,556.67 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,057.42 / $4,335.80 / $10,430.35
| Facility | | $3,057.42 | $4,335.80 | $10,430.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,485.46 / $3,963.96 / $8,212.87
| Facility | | $2,485.46 | $3,963.96 | $8,212.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,791.37 / $2,532.73 / $3,769.66
| Facility | | $1,791.37 | $2,532.73 | $3,769.66 |
- 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 |