- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,159.56 / $1,159.56 / $1,159.56
| Facility | | $1,159.56 | $1,159.56 | $1,159.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,759.58 / $17,550.78 / $36,581.76
| Facility | | $5,759.58 | $17,550.78 | $36,581.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,899.92 / $4,112.43 / $9,893.03
| Facility | | $2,899.92 | $4,112.43 | $9,893.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,357.42 / $3,759.76 / $7,789.79
| Facility | | $2,357.42 | $3,759.76 | $7,789.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,520.74 / $2,082.23 / $3,500.00
| Facility | | $1,520.74 | $2,082.23 | $3,500.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,445.00 / $3,236.00 / $5,530.00
| Facility | | $1,445.00 | $3,236.00 | $5,530.00 |