- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,388.42 / $1,388.42 / $1,388.42
| Facility | | $1,388.42 | $1,388.42 | $1,388.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,184.29 / $8,369.82 / $13,291.44
| Facility | | $4,184.29 | $8,369.82 | $13,291.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,437.28 / $4,874.49 / $11,726.24
| Facility | | $3,437.28 | $4,874.49 | $11,726.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,794.26 / $4,456.45 / $9,233.26
| Facility | | $2,794.26 | $4,456.45 | $9,233.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,803.77 / $2,477.27 / $3,558.30
| Facility | | $1,803.77 | $2,477.27 | $3,558.30 |
- 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 |