- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,387.68 / $1,387.68 / $1,387.68
| Facility | | $1,387.68 | $1,387.68 | $1,387.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,679.45 / $5,760.81 / $11,556.99
| Facility | | $2,679.45 | $5,760.81 | $11,556.99 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,064.16 / $4,345.35 / $10,453.34
| Facility | | $3,064.16 | $4,345.35 | $10,453.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,490.94 / $3,972.70 / $8,230.98
| Facility | | $2,490.94 | $3,972.70 | $8,230.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,946.04 / $2,536.59 / $3,775.39
| Facility | | $1,946.04 | $2,536.59 | $3,775.39 |
- 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 |