- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,253.32 / $1,253.32 / $1,253.32
| Facility | | $1,253.32 | $1,253.32 | $1,253.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,647.11 / $6,346.65 / $11,410.79
| Facility | | $2,647.11 | $6,346.65 | $11,410.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,177.02 / $4,505.41 / $10,838.37
| Facility | | $3,177.02 | $4,505.41 | $10,838.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,582.69 / $4,119.02 / $8,534.15
| Facility | | $2,582.69 | $4,119.02 | $8,534.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,791.27 / $2,273.17 / $3,587.02
| Facility | | $1,791.27 | $2,273.17 | $3,587.02 |
- 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 |