- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,126.04 / $1,126.04 / $1,126.04
| Facility | | $1,126.04 | $1,126.04 | $1,126.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,647.11 / $5,976.22 / $10,265.87
| Facility | | $2,647.11 | $5,976.22 | $10,265.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,847.69 / $4,038.38 / $9,714.87
| Facility | | $2,847.69 | $4,038.38 | $9,714.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,314.96 / $3,692.05 / $7,649.51
| Facility | | $2,314.96 | $3,692.05 | $7,649.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,178.44 / $2,043.10 / $3,500.00
| Facility | | $1,178.44 | $2,043.10 | $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 |