- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,166.91 / $1,166.91 / $1,166.91
| Facility | | $1,166.91 | $1,166.91 | $1,166.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,142.55 / $7,024.09 / $12,890.36
| Facility | | $4,142.55 | $7,024.09 | $12,890.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,586.59 / $3,668.11 / $8,824.12
| Facility | | $2,586.59 | $3,668.11 | $8,824.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,102.71 / $3,353.53 / $6,948.14
| Facility | | $2,102.71 | $3,353.53 | $6,948.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,586.34 / $2,138.65 / $3,500.00
| Facility | | $1,586.34 | $2,138.65 | $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 |