- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,567.65 / $1,567.65 / $1,567.65
| Facility | | $1,567.65 | $1,567.65 | $1,567.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,125.69 / $6,926.84 / $13,576.98
| Facility | | $3,125.69 | $6,926.84 | $13,576.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,644.48 / $5,168.32 / $12,433.09
| Facility | | $3,644.48 | $5,168.32 | $12,433.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,962.70 / $4,725.08 / $9,789.84
| Facility | | $2,962.70 | $4,725.08 | $9,789.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,012.02 / $2,649.33 / $3,958.51
| Facility | | $2,012.02 | $2,649.33 | $3,958.51 |
- 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 |