- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,044.13 / $1,044.13 / $1,044.13
| Facility | | $1,044.13 | $1,044.13 | $1,044.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,692.86 / $6,532.84 / $11,491.08
| Facility | | $3,692.86 | $6,532.84 | $11,491.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,595.86 / $3,681.25 / $8,855.74
| Facility | | $2,595.86 | $3,681.25 | $8,855.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,110.25 / $3,365.54 / $6,973.03
| Facility | | $2,110.25 | $3,365.54 | $6,973.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,466.07 / $1,862.25 / $3,378.00
| Facility | | $1,466.07 | $1,862.25 | $3,378.00 |
- 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 |