- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,352.39 / $1,352.39 / $1,352.39
| Facility | | $1,352.39 | $1,352.39 | $1,352.39 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,622.92 / $5,639.29 / $11,348.16
| Facility | | $2,622.92 | $5,639.29 | $11,348.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,992.56 / $4,243.83 / $10,209.10
| Facility | | $2,992.56 | $4,243.83 | $10,209.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,432.73 / $3,879.88 / $8,038.66
| Facility | | $2,432.73 | $3,879.88 | $8,038.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,959.40 / $2,484.00 / $3,697.12
| Facility | | $1,959.40 | $2,484.00 | $3,697.12 |
- 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 |