- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,777.40 / $1,777.40 / $1,777.40
| Facility | | $1,777.40 | $1,777.40 | $1,777.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,975.20 / $32,422.94 / $66,228.75
| Facility | | $8,975.20 | $32,422.94 | $66,228.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,407.82 / $6,254.06 / $15,044.99
| Facility | | $4,407.82 | $6,254.06 | $15,044.99 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,007.11 / $5,717.71 / $11,846.45
| Facility | | $4,007.11 | $5,717.71 | $11,846.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,823.21 / $3,053.00 / $4,925.59
| Facility | | $1,823.21 | $3,053.00 | $4,925.59 |
- 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 |