- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,092.50 / $1,092.50 / $1,092.50
| Facility | | $1,092.50 | $1,092.50 | $1,092.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,477.54 / $16,192.78 / $36,581.76
| Facility | | $2,477.54 | $16,192.78 | $36,581.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,539.27 / $3,963.14 / $9,533.86
| Facility | | $2,539.27 | $3,963.14 | $9,533.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,200.50 / $3,616.62 / $7,506.98
| Facility | | $2,200.50 | $3,616.62 | $7,506.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,163.24 / $1,993.09 / $3,455.00
| Facility | | $1,163.24 | $1,993.09 | $3,455.00 |
- 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 |