- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,128.82 / $1,128.82 / $1,128.82
| Facility | | $1,128.82 | $1,128.82 | $1,128.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,163.54 / $4,873.54 / $9,831.57
| Facility | | $2,163.54 | $4,873.54 | $9,831.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,499.84 / $3,545.08 / $8,528.18
| Facility | | $2,499.84 | $3,545.08 | $8,528.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,032.19 / $3,241.06 / $6,715.10
| Facility | | $2,032.19 | $3,241.06 | $6,715.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,698.23 / $2,075.16 / $3,500.00
| Facility | | $1,698.23 | $2,075.16 | $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 |