- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,252.64 / $1,252.64 / $1,252.64
| Facility | | $1,252.64 | $1,252.64 | $1,252.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,103.97 / $10,832.87 / $21,676.61
| Facility | | $6,103.97 | $10,832.87 | $21,676.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,920.38 / $4,557.96 / $10,964.80
| Facility | | $2,920.38 | $4,557.96 | $10,964.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,530.77 / $4,159.43 / $8,633.70
| Facility | | $2,530.77 | $4,159.43 | $8,633.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,252.64 / $2,116.96 / $3,912.88
| Facility | | $1,252.64 | $2,116.96 | $3,912.88 |
- 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 |