- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,202.26 / $1,202.26 / $6,760.83
| Facility | | $1,202.26 | $1,202.26 | $6,760.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,630.27 / $6,025.60 / $12,589.25
| Facility | | $2,630.27 | $6,025.60 | $12,589.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,090.30 / $4,365.16 / $10,471.29
| Facility | | $3,090.30 | $4,365.16 | $10,471.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,388.44 / $4,168.69 / $8,128.31
| Facility | | $3,388.44 | $4,168.69 | $8,128.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,230.27 / $2,344.23 / $5,370.32
| Facility | | $1,230.27 | $2,344.23 | $5,370.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,584.89 / $5,754.40 / $12,589.25
| Facility | | $1,584.89 | $5,754.40 | $12,589.25 |