- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,261.94 / $1,261.94 / $1,261.94
| Facility | | $1,261.94 | $1,261.94 | $1,261.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,184.29 / $7,567.95 / $15,246.57
| Facility | | $4,184.29 | $7,567.95 | $15,246.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,944.87 / $4,596.18 / $11,056.75
| Facility | | $2,944.87 | $4,596.18 | $11,056.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,551.98 / $4,194.32 / $8,706.10
| Facility | | $2,551.98 | $4,194.32 | $8,706.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,338.60 / $2,309.80 / $3,995.33
| Facility | | $1,338.60 | $2,309.80 | $3,995.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,623.00 / $4,746.00 / $8,812.00
| Facility | | $1,623.00 | $4,746.00 | $8,812.00 |