- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,664.45 / $1,664.45 / $1,664.45
| Facility | | $1,664.45 | $1,664.45 | $1,664.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,527.12 / $3,895.97 / $13,784.81
| Facility | | $1,527.12 | $3,895.97 | $13,784.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,878.54 / $6,053.40 / $14,562.26
| Facility | | $3,878.54 | $6,053.40 | $14,562.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,361.10 / $5,524.12 / $11,466.35
| Facility | | $3,361.10 | $5,524.12 | $11,466.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,709.26 / $2,819.48 / $5,155.62
| Facility | | $1,709.26 | $2,819.48 | $5,155.62 |
- 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 |