- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,398.62 / $1,398.62 / $1,398.62
| Facility | | $1,398.62 | $1,398.62 | $1,398.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,106.76 / $2,401.69 / $11,665.27
| Facility | | $1,106.76 | $2,401.69 | $11,665.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,258.65 / $5,085.89 / $12,234.83
| Facility | | $3,258.65 | $5,085.89 | $12,234.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,823.91 / $4,641.22 / $9,633.73
| Facility | | $2,823.91 | $4,641.22 | $9,633.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,476.74 / $2,406.85 / $4,337.02
| Facility | | $1,476.74 | $2,406.85 | $4,337.02 |
- 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 |