- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,232.27 / $1,232.27 / $1,232.27
| Facility | | $1,232.27 | $1,232.27 | $1,232.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,081.85 / $2,401.69 / $10,261.70
| Facility | | $1,081.85 | $2,401.69 | $10,261.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,866.05 / $4,473.16 / $10,760.79
| Facility | | $2,866.05 | $4,473.16 | $10,760.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,483.67 / $4,082.05 / $8,473.06
| Facility | | $2,483.67 | $4,082.05 | $8,473.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,255.28 / $2,110.81 / $3,839.05
| Facility | | $1,255.28 | $2,110.81 | $3,839.05 |
- 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 |