- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,068.15 / $1,068.15 / $1,068.15
| Facility | | $1,068.15 | $1,068.15 | $1,068.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,023.80 / $9,560.76 / $20,316.56
| Facility | | $5,023.80 | $9,560.76 | $20,316.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,357.50 / $3,343.22 / $8,042.58
| Facility | | $2,357.50 | $3,343.22 | $8,042.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,916.48 / $3,056.51 / $6,332.74
| Facility | | $1,916.48 | $3,056.51 | $6,332.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,573.62 / $1,949.10 / $3,500.00
| Facility | | $1,573.62 | $1,949.10 | $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 |