- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,223.84 / $1,223.84 / $1,223.84
| Facility | | $1,223.84 | $1,223.84 | $1,223.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,647.11 / $6,173.13 / $11,098.81
| Facility | | $2,647.11 | $6,173.13 | $11,098.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,098.69 / $4,394.33 / $10,571.15
| Facility | | $3,098.69 | $4,394.33 | $10,571.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,519.01 / $4,017.47 / $8,323.74
| Facility | | $2,519.01 | $4,017.47 | $8,323.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,737.67 / $2,217.02 / $3,500.00
| Facility | | $1,737.67 | $2,217.02 | $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 |