- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,389.87 / $1,389.87 / $1,389.87
| Facility | | $1,389.87 | $1,389.87 | $1,389.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,224.41 / $3,144.69 / $11,626.50
| Facility | | $1,224.41 | $3,144.69 | $11,626.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,234.16 / $5,047.68 / $12,142.88
| Facility | | $3,234.16 | $5,047.68 | $12,142.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,802.68 / $4,606.34 / $9,561.33
| Facility | | $2,802.68 | $4,606.34 | $9,561.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,460.10 / $2,377.36 / $4,338.02
| Facility | | $1,460.10 | $2,377.36 | $4,338.02 |
- 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 |