- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,550.72 / $1,550.72 / $34,437.50
| Facility | | $1,550.72 | $1,550.72 | $34,437.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,662.57 / $9,526.51 / $15,128.27
| Facility | | $4,662.57 | $9,526.51 | $15,128.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,611.45 / $5,636.54 / $13,559.46
| Facility | | $3,611.45 | $5,636.54 | $13,559.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,129.64 / $5,143.71 / $10,676.74
| Facility | | $3,129.64 | $5,143.71 | $10,676.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,679.21 / $2,844.23 / $5,266.11
| Facility | | $1,679.21 | $2,844.23 | $5,266.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $875.00 / $5,530.00 / $11,890.00
| Facility | | $875.00 | $5,530.00 | $11,890.00 |