- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,057.68 / $1,057.68 / $1,057.68
| Facility | | $1,057.68 | $1,057.68 | $1,057.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,635.84 / $5,619.23 / $9,645.45
| Facility | | $2,635.84 | $5,619.23 | $9,645.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,673.35 / $3,791.14 / $9,120.09
| Facility | | $2,673.35 | $3,791.14 | $9,120.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,173.23 / $3,466.01 / $7,181.18
| Facility | | $2,173.23 | $3,466.01 | $7,181.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,463.42 / $1,911.12 / $3,378.00
| Facility | | $1,463.42 | $1,911.12 | $3,378.00 |
- 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 |