- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,124.35 / $1,124.35 / $1,124.35
| Facility | | $1,124.35 | $1,124.35 | $1,124.35 |
- 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
- $2,486.36 / $3,525.97 / $8,482.20
| Facility | | $2,486.36 | $3,525.97 | $8,482.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,021.23 / $3,223.58 / $6,678.90
| Facility | | $2,021.23 | $3,223.58 | $6,678.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,521.77 / $2,056.91 / $3,500.00
| Facility | | $1,521.77 | $2,056.91 | $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 |