- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,103.49 / $1,103.49 / $1,103.49
| Facility | | $1,103.49 | $1,103.49 | $1,103.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,173.08 / $2,992.74 / $9,194.19
| Facility | | $1,173.08 | $2,992.74 | $9,194.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,575.23 / $4,019.27 / $9,668.91
| Facility | | $2,575.23 | $4,019.27 | $9,668.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,231.67 / $3,667.85 / $7,613.31
| Facility | | $2,231.67 | $3,667.85 | $7,613.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,167.32 / $1,972.67 / $3,500.00
| Facility | | $1,167.32 | $1,972.67 | $3,500.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $796.00 / $3,500.00 / $8,152.00
| Facility | | $796.00 | $3,500.00 | $8,152.00 |