- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,219.90 / $1,219.90 / $1,219.90
| Facility | | $1,219.90 | $1,219.90 | $1,219.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,173.08 / $2,992.74 / $10,194.50
| Facility | | $1,173.08 | $2,992.74 | $10,194.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,842.32 / $4,436.13 / $10,671.71
| Facility | | $2,842.32 | $4,436.13 | $10,671.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,463.12 / $4,048.26 / $8,402.93
| Facility | | $2,463.12 | $4,048.26 | $8,402.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,228.40 / $2,106.14 / $3,874.11
| Facility | | $1,228.40 | $2,106.14 | $3,874.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,100.00 / $5,499.00 / $9,810.00
| Facility | | $2,100.00 | $5,499.00 | $9,810.00 |