- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,404.36 / $1,404.36 / $1,404.36
| Facility | | $1,404.36 | $1,404.36 | $1,404.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,713.62 / $13,463.08 / $26,448.94
| Facility | | $6,713.62 | $13,463.08 | $26,448.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,466.66 / $4,918.68 / $11,832.56
| Facility | | $3,466.66 | $4,918.68 | $11,832.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,151.51 / $4,496.85 / $9,316.98
| Facility | | $3,151.51 | $4,496.85 | $9,316.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,533.66 / $2,521.21 / $5,987.70
| Facility | | $1,533.66 | $2,521.21 | $5,987.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,028.00 / $11,496.00 / $21,528.00
| Facility | | $5,028.00 | $11,496.00 | $21,528.00 |