- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,182.22 / $1,182.22 / $1,182.22
| Facility | | $1,182.22 | $1,182.22 | $1,182.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,178.08 / $3,144.69 / $9,853.31
| Facility | | $1,178.08 | $3,144.69 | $9,853.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,757.38 / $4,303.55 / $10,352.77
| Facility | | $2,757.38 | $4,303.55 | $10,352.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,389.51 / $3,927.27 / $8,151.79
| Facility | | $2,389.51 | $3,927.27 | $8,151.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,174.44 / $2,028.88 / $3,690.78
| Facility | | $1,174.44 | $2,028.88 | $3,690.78 |
- 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 |