- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,205.45 / $1,205.45 / $1,205.45
| Facility | | $1,205.45 | $1,205.45 | $1,205.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,178.08 / $3,144.69 / $10,018.74
| Facility | | $1,178.08 | $3,144.69 | $10,018.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,809.42 / $4,384.77 / $10,548.16
| Facility | | $2,809.42 | $4,384.77 | $10,548.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,434.61 / $4,001.39 / $8,305.64
| Facility | | $2,434.61 | $4,001.39 | $8,305.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,281.33 / $2,097.00 / $3,765.50
| Facility | | $1,281.33 | $2,097.00 | $3,765.50 |
- 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 |