- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,651.45 / $1,651.45 / $1,651.45
| Facility | | $1,651.45 | $1,651.45 | $1,651.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,433.37 / $32,422.94 / $66,228.75
| Facility | | $8,433.37 | $32,422.94 | $66,228.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,065.20 / $5,767.93 / $13,875.53
| Facility | | $4,065.20 | $5,767.93 | $13,875.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,695.63 / $5,273.27 / $10,925.61
| Facility | | $3,695.63 | $5,273.27 | $10,925.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,729.67 / $2,830.37 / $4,560.05
| Facility | | $1,729.67 | $2,830.37 | $4,560.05 |
- 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 |