- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,403.90 / $1,403.90 / $1,403.90
| Facility | | $1,403.90 | $1,403.90 | $1,403.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,626.61 / $11,528.03 / $22,633.97
| Facility | | $6,626.61 | $11,528.03 | $22,633.97 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,271.66 / $5,106.21 / $12,283.68
| Facility | | $3,271.66 | $5,106.21 | $12,283.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,835.18 / $4,659.75 / $9,672.19
| Facility | | $2,835.18 | $4,659.75 | $9,672.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,492.43 / $2,430.61 / $4,375.07
| Facility | | $1,492.43 | $2,430.61 | $4,375.07 |
- 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 |