- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,314.03 / $1,314.03 / $1,314.03
| Facility | | $1,314.03 | $1,314.03 | $1,314.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $988.21 / $2,110.42 / $9,954.12
| Facility | | $988.21 | $2,110.42 | $9,954.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,901.60 / $4,114.83 / $9,898.78
| Facility | | $2,901.60 | $4,114.83 | $9,898.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,358.79 / $3,761.94 / $7,794.31
| Facility | | $2,358.79 | $3,761.94 | $7,794.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,850.14 / $2,403.83 / $3,577.79
| Facility | | $1,850.14 | $2,403.83 | $3,577.79 |
- 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 |