- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,385.20 / $1,385.20 / $1,385.20
| Facility | | $1,385.20 | $1,385.20 | $1,385.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,531.92 / $13,126.55 / $26,448.94
| Facility | | $6,531.92 | $13,126.55 | $26,448.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,401.84 / $4,826.71 / $11,611.31
| Facility | | $3,401.84 | $4,826.71 | $11,611.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,092.58 / $4,412.77 / $9,142.76
| Facility | | $3,092.58 | $4,412.77 | $9,142.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,462.48 / $2,393.15 / $3,898.02
| Facility | | $1,462.48 | $2,393.15 | $3,898.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,720.00 / $3,500.00 / $8,152.00
| Facility | | $1,720.00 | $3,500.00 | $8,152.00 |