- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,276.08 / $1,276.08 / $1,276.08
| Facility | | $1,276.08 | $1,276.08 | $1,276.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,473.73 / $5,318.55 / $10,610.11
| Facility | | $2,473.73 | $5,318.55 | $10,610.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,824.11 / $4,004.94 / $9,634.43
| Facility | | $2,824.11 | $4,004.94 | $9,634.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,295.80 / $3,661.48 / $7,586.16
| Facility | | $2,295.80 | $3,661.48 | $7,586.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,794.21 / $2,342.62 / $3,500.00
| Facility | | $1,794.21 | $2,342.62 | $3,500.00 |
- 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 |