- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,213.64 / $1,213.64 / $1,213.64
| Facility | | $1,213.64 | $1,213.64 | $1,213.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,178.08 / $3,144.69 / $10,003.23
| Facility | | $1,178.08 | $3,144.69 | $10,003.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,835.44 / $4,425.38 / $10,645.85
| Facility | | $2,835.44 | $4,425.38 | $10,645.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,457.16 / $4,038.45 / $8,382.56
| Facility | | $2,457.16 | $4,038.45 | $8,382.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,246.28 / $2,076.41 / $3,796.86
| Facility | | $1,246.28 | $2,076.41 | $3,796.86 |
- 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 |