- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,291.67 / $1,291.67 / $1,291.67
| Facility | | $1,291.67 | $1,291.67 | $1,291.67 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,184.29 / $7,846.36 / $13,020.23
| Facility | | $4,184.29 | $7,846.36 | $13,020.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,196.39 / $4,532.88 / $10,904.46
| Facility | | $3,196.39 | $4,532.88 | $10,904.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,598.44 / $4,144.14 / $8,586.19
| Facility | | $2,598.44 | $4,144.14 | $8,586.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,702.02 / $2,280.19 / $3,500.00
| Facility | | $1,702.02 | $2,280.19 | $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 |