- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,227.53 / $1,227.53 / $1,227.53
| Facility | | $1,227.53 | $1,227.53 | $1,227.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,350.17 / $10,415.11 / $20,316.56
| Facility | | $5,350.17 | $10,415.11 | $20,316.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,735.67 / $3,879.52 / $9,332.71
| Facility | | $2,735.67 | $3,879.52 | $9,332.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,223.91 / $3,546.82 / $7,348.60
| Facility | | $2,223.91 | $3,546.82 | $7,348.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,696.39 / $2,230.65 / $3,500.00
| Facility | | $1,696.39 | $2,230.65 | $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 |