- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,065.36 / $1,065.36 / $1,065.36
| Facility | | $1,065.36 | $1,065.36 | $1,065.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,696.09 / $11,540.50 / $22,684.35
| Facility | | $6,696.09 | $11,540.50 | $22,684.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,702.83 / $3,832.94 / $9,220.66
| Facility | | $2,702.83 | $3,832.94 | $9,220.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,197.19 / $3,504.23 / $7,260.36
| Facility | | $2,197.19 | $3,504.23 | $7,260.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,494.81 / $2,247.14 / $8,388.60
| Facility | | $1,494.81 | $2,247.14 | $8,388.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,940.00 / $8,689.00 / $11,531.00
| Facility | | $3,940.00 | $8,689.00 | $11,531.00 |