- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,117.47 / $1,117.47 / $1,117.47
| Facility | | $1,117.47 | $1,117.47 | $1,117.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,124.92 / $6,830.64 / $12,890.36
| Facility | | $4,124.92 | $6,830.64 | $12,890.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,404.57 / $3,752.91 / $9,028.14
| Facility | | $2,404.57 | $3,752.91 | $9,028.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,083.77 / $3,424.78 / $7,108.78
| Facility | | $2,083.77 | $3,424.78 | $7,108.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,095.43 / $1,888.52 / $3,274.88
| Facility | | $1,095.43 | $1,888.52 | $3,274.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $796.00 / $3,500.00 / $8,152.00
| Facility | | $796.00 | $3,500.00 | $8,152.00 |