- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,131.10 / $1,131.10 / $8,657.00
| Facility | | $1,131.10 | $1,131.10 | $8,657.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,647.11 / $5,971.08 / $10,257.04
| Facility | | $2,647.11 | $5,971.08 | $10,257.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,867.91 / $4,067.05 / $9,783.84
| Facility | | $2,867.91 | $4,067.05 | $9,783.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,331.40 / $3,718.26 / $7,703.81
| Facility | | $2,331.40 | $3,718.26 | $7,703.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,608.70 / $2,097.00 / $3,550.24
| Facility | | $1,608.70 | $2,097.00 | $3,550.24 |
- 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 |