- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,167.66 / $1,167.66 / $1,167.66
| Facility | | $1,167.66 | $1,167.66 | $1,167.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,234.55 / $10,206.81 / $20,316.56
| Facility | | $5,234.55 | $10,206.81 | $20,316.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,585.75 / $3,666.92 / $8,821.26
| Facility | | $2,585.75 | $3,666.92 | $8,821.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,102.03 / $3,352.44 / $6,945.88
| Facility | | $2,102.03 | $3,352.44 | $6,945.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,684.66 / $2,135.36 / $3,500.00
| Facility | | $1,684.66 | $2,135.36 | $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 |