- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,854.37 / $1,854.37 / $1,854.37
| Facility | | $1,854.37 | $1,854.37 | $1,854.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,466.88 / $12,225.47 / $23,333.99
| Facility | | $7,466.88 | $12,225.47 | $23,333.99 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,326.24 / $6,752.14 / $16,243.19
| Facility | | $4,326.24 | $6,752.14 | $16,243.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,749.07 / $6,161.77 / $12,789.91
| Facility | | $3,749.07 | $6,161.77 | $12,789.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,854.37 / $3,151.49 / $5,762.72
| Facility | | $1,854.37 | $3,151.49 | $5,762.72 |
- 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 |