- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,430.40 / $1,430.40 / $1,430.40
| Facility | | $1,430.40 | $1,430.40 | $1,430.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,282.65 / $10,979.34 / $21,556.67
| Facility | | $6,282.65 | $10,979.34 | $21,556.67 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,161.02 / $4,482.71 / $10,783.78
| Facility | | $3,161.02 | $4,482.71 | $10,783.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,569.67 / $4,098.28 / $8,491.16
| Facility | | $2,569.67 | $4,098.28 | $8,491.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,850.31 / $2,618.17 / $3,896.83
| Facility | | $1,850.31 | $2,618.17 | $3,896.83 |
- 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 |