- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,247.55 / $1,247.55 / $1,247.55
| Facility | | $1,247.55 | $1,247.55 | $1,247.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,444.42 / $10,430.79 / $21,131.14
| Facility | | $5,444.42 | $10,430.79 | $21,131.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,773.58 / $3,933.27 / $9,462.02
| Facility | | $2,773.58 | $3,933.27 | $9,462.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,254.71 / $3,595.96 / $7,450.41
| Facility | | $2,254.71 | $3,595.96 | $7,450.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $853.08 / $2,108.36 / $3,500.00
| Facility | | $853.08 | $2,108.36 | $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 |