- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,050.13 / $1,050.13 / $1,050.13
| Facility | | $1,050.13 | $1,050.13 | $1,050.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,692.86 / $6,469.04 / $11,491.08
| Facility | | $3,692.86 | $6,469.04 | $11,491.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,563.85 / $3,635.86 / $8,746.54
| Facility | | $2,563.85 | $3,635.86 | $8,746.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,084.23 / $3,324.05 / $6,887.05
| Facility | | $2,084.23 | $3,324.05 | $6,887.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,492.53 / $1,835.37 / $3,378.00
| Facility | | $1,492.53 | $1,835.37 | $3,378.00 |
- 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 |