- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,296.73 / $1,296.73 / $1,296.73
| Facility | | $1,296.73 | $1,296.73 | $1,296.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,173.08 / $2,992.74 / $10,879.48
| Facility | | $1,173.08 | $2,992.74 | $10,879.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,025.23 / $4,721.60 / $11,358.45
| Facility | | $3,025.23 | $4,721.60 | $11,358.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,621.63 / $4,308.77 / $8,943.66
| Facility | | $2,621.63 | $4,308.77 | $8,943.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,384.20 / $2,249.17 / $4,053.47
| Facility | | $1,384.20 | $2,249.17 | $4,053.47 |
- 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 |