- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,124.83 / $1,124.83 / $1,124.83
| Facility | | $1,124.83 | $1,124.83 | $1,124.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,142.55 / $6,830.64 / $12,890.36
| Facility | | $4,142.55 | $6,830.64 | $12,890.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,478.78 / $3,515.22 / $8,456.34
| Facility | | $2,478.78 | $3,515.22 | $8,456.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,015.07 / $3,213.76 / $6,658.54
| Facility | | $2,015.07 | $3,213.76 | $6,658.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,635.97 / $2,031.32 / $3,500.00
| Facility | | $1,635.97 | $2,031.32 | $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 |