- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,246.23 / $1,246.23 / $1,246.23
| Facility | | $1,246.23 | $1,246.23 | $1,246.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,124.92 / $7,222.80 / $12,890.36
| Facility | | $4,124.92 | $7,222.80 | $12,890.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,680.08 / $4,182.91 / $10,062.56
| Facility | | $2,680.08 | $4,182.91 | $10,062.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,322.53 / $3,817.18 / $7,923.28
| Facility | | $2,322.53 | $3,817.18 | $7,923.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,230.57 / $2,106.13 / $3,588.51
| Facility | | $1,230.57 | $2,106.13 | $3,588.51 |
- 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 |