- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,024.07 / $1,024.07 / $1,024.07
| Facility | | $1,024.07 | $1,024.07 | $1,024.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,527.12 / $3,895.97 / $8,611.41
| Facility | | $1,527.12 | $3,895.97 | $8,611.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,392.33 / $3,733.80 / $8,982.17
| Facility | | $2,392.33 | $3,733.80 | $8,982.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,073.16 / $3,407.34 / $7,072.58
| Facility | | $2,073.16 | $3,407.34 | $7,072.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,101.00 / $1,854.05 / $3,367.87
| Facility | | $1,101.00 | $1,854.05 | $3,367.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,437.00 / $9,370.00 / $12,774.00
| Facility | | $3,437.00 | $9,370.00 | $12,774.00 |