- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,311.76 / $1,311.76 / $1,311.76
| Facility | | $1,311.76 | $1,311.76 | $1,311.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,758.60 / $10,415.11 / $20,450.14
| Facility | | $5,758.60 | $10,415.11 | $20,450.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,902.44 / $4,116.02 / $9,901.65
| Facility | | $2,902.44 | $4,116.02 | $9,901.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,359.48 / $3,763.03 / $7,796.58
| Facility | | $2,359.48 | $3,763.03 | $7,796.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,917.54 / $2,403.38 / $3,577.12
| Facility | | $1,917.54 | $2,403.38 | $3,577.12 |
- 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 |