- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,151.39 / $1,151.39 / $1,151.39
| Facility | | $1,151.39 | $1,151.39 | $1,151.39 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,692.86 / $6,532.84 / $11,491.08
| Facility | | $3,692.86 | $6,532.84 | $11,491.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,690.19 / $3,815.03 / $9,177.56
| Facility | | $2,690.19 | $3,815.03 | $9,177.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,186.92 / $3,487.85 / $7,226.43
| Facility | | $2,186.92 | $3,487.85 | $7,226.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,136.18 / $1,945.85 / $3,378.00
| Facility | | $1,136.18 | $1,945.85 | $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 |