- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,122.22 / $1,122.22 / $1,122.22
| Facility | | $1,122.22 | $1,122.22 | $1,122.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,673.02 / $11,589.55 / $24,627.71
| Facility | | $5,673.02 | $11,589.55 | $24,627.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,772.73 / $3,932.08 / $9,459.15
| Facility | | $2,772.73 | $3,932.08 | $9,459.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,254.03 / $3,594.86 / $7,448.15
| Facility | | $2,254.03 | $3,594.86 | $7,448.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,402.50 / $1,992.78 / $3,433.92
| Facility | | $1,402.50 | $1,992.78 | $3,433.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,751.00 / $3,500.00 / $8,152.00
| Facility | | $1,751.00 | $3,500.00 | $8,152.00 |