- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,034.49 / $1,034.49 / $1,034.49
| Facility | | $1,034.49 | $1,034.49 | $1,034.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,142.55 / $6,699.52 / $12,890.36
| Facility | | $4,142.55 | $6,699.52 | $12,890.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,480.46 / $3,517.61 / $8,462.09
| Facility | | $2,480.46 | $3,517.61 | $8,462.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,016.44 / $3,215.94 / $6,663.06
| Facility | | $2,016.44 | $3,215.94 | $6,663.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,379.51 / $1,778.48 / $3,378.00
| Facility | | $1,379.51 | $1,778.48 | $3,378.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,445.00 / $3,236.00 / $5,530.00
| Facility | | $1,445.00 | $3,236.00 | $5,530.00 |