- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,124.46 / $1,124.46 / $1,124.46
| Facility | | $1,124.46 | $1,124.46 | $1,124.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,234.55 / $9,961.04 / $20,316.56
| Facility | | $5,234.55 | $9,961.04 | $20,316.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,490.57 / $3,531.94 / $8,496.57
| Facility | | $2,490.57 | $3,531.94 | $8,496.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,024.66 / $3,229.04 / $6,690.21
| Facility | | $2,024.66 | $3,229.04 | $6,690.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,657.31 / $1,995.93 / $3,500.00
| Facility | | $1,657.31 | $1,995.93 | $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 |