- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,384.04 / $1,384.04 / $1,384.04
| Facility | | $1,384.04 | $1,384.04 | $1,384.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,640.67 / $5,677.44 / $11,242.32
| Facility | | $2,640.67 | $5,677.44 | $11,242.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,070.89 / $4,354.91 / $10,476.33
| Facility | | $3,070.89 | $4,354.91 | $10,476.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,496.42 / $3,981.43 / $8,249.08
| Facility | | $2,496.42 | $3,981.43 | $8,249.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,805.57 / $2,552.14 / $3,798.53
| Facility | | $1,805.57 | $2,552.14 | $3,798.53 |
- 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 |