- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,750.10 / $1,750.10 / $1,750.10
| Facility | | $1,750.10 | $1,750.10 | $1,750.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,642.72 / $9,897.61 / $16,989.34
| Facility | | $4,642.72 | $9,897.61 | $16,989.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,073.69 / $6,357.98 / $15,294.98
| Facility | | $4,073.69 | $6,357.98 | $15,294.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,530.21 / $5,802.07 / $12,043.29
| Facility | | $3,530.21 | $5,802.07 | $12,043.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,864.94 / $3,129.86 / $5,467.78
| Facility | | $1,864.94 | $3,129.86 | $5,467.78 |
- 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 |