- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,256.36 / $1,256.36 / $1,256.36
| Facility | | $1,256.36 | $1,256.36 | $1,256.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,973.55 / $5,034.89 / $11,070.22
| Facility | | $1,973.55 | $5,034.89 | $11,070.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,915.79 / $4,550.80 / $10,947.56
| Facility | | $2,915.79 | $4,550.80 | $10,947.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,526.79 / $4,152.89 / $8,620.12
| Facility | | $2,526.79 | $4,152.89 | $8,620.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,209.27 / $2,123.27 / $3,802.46
| Facility | | $1,209.27 | $2,123.27 | $3,802.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $796.00 / $3,500.00 / $8,152.00
| Facility | | $796.00 | $3,500.00 | $8,152.00 |