- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,464.40 / $1,464.40 / $1,464.40
| Facility | | $1,464.40 | $1,464.40 | $1,464.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,288.32 / $2,992.74 / $12,259.77
| Facility | | $1,288.32 | $2,992.74 | $12,259.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,410.94 / $5,323.60 / $12,806.63
| Facility | | $3,410.94 | $5,323.60 | $12,806.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,955.88 / $4,858.13 / $10,083.95
| Facility | | $2,955.88 | $4,858.13 | $10,083.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,534.00 / $2,530.05 / $4,562.53
| Facility | | $1,534.00 | $2,530.05 | $4,562.53 |
- 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 |