- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,206.19 / $1,206.19 / $1,206.19
| Facility | | $1,206.19 | $1,206.19 | $1,206.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,173.08 / $2,992.74 / $10,091.11
| Facility | | $1,173.08 | $2,992.74 | $10,091.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,824.72 / $4,408.66 / $10,605.63
| Facility | | $2,824.72 | $4,408.66 | $10,605.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,447.87 / $4,023.19 / $8,350.89
| Facility | | $2,447.87 | $4,023.19 | $8,350.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,278.97 / $2,097.00 / $3,767.81
| Facility | | $1,278.97 | $2,097.00 | $3,767.81 |
- 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 |