- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,079.84 / $1,079.84 / $1,079.84
| Facility | | $1,079.84 | $1,079.84 | $1,079.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,038.22 / $9,560.76 / $20,316.56
| Facility | | $5,038.22 | $9,560.76 | $20,316.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,386.98 / $3,385.03 / $8,143.14
| Facility | | $2,386.98 | $3,385.03 | $8,143.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,940.44 / $3,094.73 / $6,411.93
| Facility | | $1,940.44 | $3,094.73 | $6,411.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,541.73 / $1,976.50 / $3,500.00
| Facility | | $1,541.73 | $1,976.50 | $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 |