- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,368.78 / $1,368.78 / $1,368.78
| Facility | | $1,368.78 | $1,368.78 | $1,368.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,660.39 / $5,719.84 / $11,505.50
| Facility | | $2,660.39 | $5,719.84 | $11,505.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,038.89 / $4,309.52 / $10,367.14
| Facility | | $3,038.89 | $4,309.52 | $10,367.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,470.40 / $3,939.94 / $8,163.10
| Facility | | $2,470.40 | $3,939.94 | $8,163.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,968.90 / $2,528.51 / $3,763.36
| Facility | | $1,968.90 | $2,528.51 | $3,763.36 |
- 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 |