- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,136.48 / $1,136.48 / $1,136.48
| Facility | | $1,136.48 | $1,136.48 | $1,136.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,181.94 / $4,848.63 / $9,723.16
| Facility | | $2,181.94 | $4,848.63 | $9,723.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,508.26 / $3,557.03 / $8,556.91
| Facility | | $2,508.26 | $3,557.03 | $8,556.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,039.04 / $3,251.98 / $6,737.73
| Facility | | $2,039.04 | $3,251.98 | $6,737.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,589.51 / $2,062.44 / $3,500.00
| Facility | | $1,589.51 | $2,062.44 | $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 |