- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,163.16 / $1,163.16 / $8,656.40
| Facility | | $1,163.16 | $1,163.16 | $8,656.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,372.66 / $4,416.67 / $8,281.67
| Facility | | $2,372.66 | $4,416.67 | $8,281.67 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,710.69 / $3,846.08 / $9,252.27
| Facility | | $2,710.69 | $3,846.08 | $9,252.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,204.73 / $3,516.24 / $7,285.25
| Facility | | $2,204.73 | $3,516.24 | $7,285.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,198.90 / $2,057.07 / $6,740.00
| Facility | | $1,198.90 | $2,057.07 | $6,740.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,735.00 / $4,974.00 / $8,812.00
| Facility | | $2,735.00 | $4,974.00 | $8,812.00 |