- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,300.42 / $1,300.42 / $1,300.42
| Facility | | $1,300.42 | $1,300.42 | $1,300.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,692.86 / $7,355.36 / $11,680.44
| Facility | | $3,692.86 | $7,355.36 | $11,680.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,020.36 / $4,283.24 / $10,303.92
| Facility | | $3,020.36 | $4,283.24 | $10,303.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,455.33 / $3,915.91 / $8,113.33
| Facility | | $2,455.33 | $3,915.91 | $8,113.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,690.95 / $2,406.60 / $3,731.74
| Facility | | $1,690.95 | $2,406.60 | $3,731.74 |
- 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 |