- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,119.39 / $1,119.39 / $1,119.39
| Facility | | $1,119.39 | $1,119.39 | $1,119.39 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,502.86 / $16,192.78 / $36,581.76
| Facility | | $2,502.86 | $16,192.78 | $36,581.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,615.80 / $4,082.58 / $9,821.20
| Facility | | $2,615.80 | $4,082.58 | $9,821.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,266.82 / $3,725.62 / $7,733.23
| Facility | | $2,266.82 | $3,725.62 | $7,733.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,194.19 / $2,061.84 / $3,566.43
| Facility | | $1,194.19 | $2,061.84 | $3,566.43 |
- 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 |