- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,294.24 / $1,294.24 / $1,294.24
| Facility | | $1,294.24 | $1,294.24 | $1,294.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,178.08 / $3,144.69 / $10,822.61
| Facility | | $1,178.08 | $3,144.69 | $10,822.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,018.34 / $4,710.85 / $11,332.59
| Facility | | $3,018.34 | $4,710.85 | $11,332.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,615.66 / $4,298.96 / $8,923.29
| Facility | | $2,615.66 | $4,298.96 | $8,923.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,322.52 / $2,187.27 / $4,030.53
| Facility | | $1,322.52 | $2,187.27 | $4,030.53 |
- 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 |