- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,230.60 / $1,230.60 / $1,230.60
| Facility | | $1,230.60 | $1,230.60 | $1,230.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,166.47 / $7,611.14 / $13,020.23
| Facility | | $4,166.47 | $7,611.14 | $13,020.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,039.73 / $4,310.72 / $10,370.01
| Facility | | $3,039.73 | $4,310.72 | $10,370.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,471.08 / $3,941.03 / $8,165.36
| Facility | | $2,471.08 | $3,941.03 | $8,165.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,597.71 / $2,194.88 / $3,500.00
| Facility | | $1,597.71 | $2,194.88 | $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 |