- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,199.60 / $1,199.60 / $1,199.60
| Facility | | $1,199.60 | $1,199.60 | $1,199.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,357.79 / $4,001.16 / $7,238.46
| Facility | | $2,357.79 | $4,001.16 | $7,238.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,037.20 / $4,307.13 / $10,361.39
| Facility | | $3,037.20 | $4,307.13 | $10,361.39 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,469.03 / $3,937.75 / $8,158.58
| Facility | | $2,469.03 | $3,937.75 | $8,158.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,703.01 / $2,172.81 / $3,500.00
| Facility | | $1,703.01 | $2,172.81 | $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 |