- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,347.34 / $1,347.34 / $1,347.34
| Facility | | $1,347.34 | $1,347.34 | $1,347.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,447.52 / $5,784.07 / $11,431.39
| Facility | | $2,447.52 | $5,784.07 | $11,431.39 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,009.41 / $4,267.72 / $10,266.57
| Facility | | $3,009.41 | $4,267.72 | $10,266.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,446.42 / $3,901.72 / $8,083.91
| Facility | | $2,446.42 | $3,901.72 | $8,083.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,726.47 / $2,490.71 / $6,927.00
| Facility | | $1,726.47 | $2,490.71 | $6,927.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,445.00 / $4,968.00 / $9,787.00
| Facility | | $1,445.00 | $4,968.00 | $9,787.00 |