- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,650.76 / $1,650.76 / $1,650.76
| Facility | | $1,650.76 | $1,650.76 | $1,650.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,174.32 / $6,824.79 / $13,553.72
| Facility | | $3,174.32 | $6,824.79 | $13,553.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,659.64 / $5,189.82 / $12,484.81
| Facility | | $3,659.64 | $5,189.82 | $12,484.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,975.02 / $4,744.74 / $9,830.56
| Facility | | $2,975.02 | $4,744.74 | $9,830.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,776.48 / $2,993.67 / $4,094.67
| Facility | | $1,776.48 | $2,993.67 | $4,094.67 |
- 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 |