- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,164.60 / $1,164.60 / $1,164.60
| Facility | | $1,164.60 | $1,164.60 | $1,164.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,166.47 / $7,203.30 / $13,020.23
| Facility | | $4,166.47 | $7,203.30 | $13,020.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,886.44 / $4,093.33 / $9,847.06
| Facility | | $2,886.44 | $4,093.33 | $9,847.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,346.46 / $3,742.28 / $7,753.59
| Facility | | $2,346.46 | $3,742.28 | $7,753.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,483.24 / $2,078.28 / $3,500.00
| Facility | | $1,483.24 | $2,078.28 | $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 |