- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,448.79 / $1,448.79 / $1,448.79
| Facility | | $1,448.79 | $1,448.79 | $1,448.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,273.06 / $3,144.69 / $12,151.21
| Facility | | $1,273.06 | $3,144.69 | $12,151.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,371.91 / $5,262.68 / $12,660.09
| Facility | | $3,371.91 | $5,262.68 | $12,660.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,922.06 / $4,802.54 / $9,968.58
| Facility | | $2,922.06 | $4,802.54 | $9,968.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,433.28 / $2,448.46 / $4,511.10
| Facility | | $1,433.28 | $2,448.46 | $4,511.10 |
- 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 |