- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,297.83 / $1,297.83 / $1,297.83
| Facility | | $1,297.83 | $1,297.83 | $1,297.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,507.91 / $5,392.02 / $10,856.13
| Facility | | $2,507.91 | $5,392.02 | $10,856.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,874.65 / $4,076.61 / $9,806.83
| Facility | | $2,874.65 | $4,076.61 | $9,806.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,336.88 / $3,727.00 / $7,721.91
| Facility | | $2,336.88 | $3,727.00 | $7,721.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,561.34 / $2,386.82 / $3,552.48
| Facility | | $1,561.34 | $2,386.82 | $3,552.48 |
- 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 |