- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,299.38 / $1,299.38 / $1,299.38
| Facility | | $1,299.38 | $1,299.38 | $1,299.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,692.86 / $7,339.59 / $11,556.99
| Facility | | $3,692.86 | $7,339.59 | $11,556.99 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,025.41 / $4,290.41 / $10,321.16
| Facility | | $3,025.41 | $4,290.41 | $10,321.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,459.44 / $3,922.46 / $8,126.90
| Facility | | $2,459.44 | $3,922.46 | $8,126.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,792.98 / $2,287.60 / $3,500.00
| Facility | | $1,792.98 | $2,287.60 | $3,500.00 |
- 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 |