- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,041.07 / $1,041.07 / $1,041.07
| Facility | | $1,041.07 | $1,041.07 | $1,041.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,511.39 / $7,107.25 / $14,098.13
| Facility | | $4,511.39 | $7,107.25 | $14,098.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,643.02 / $3,748.14 / $9,016.65
| Facility | | $2,643.02 | $3,748.14 | $9,016.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,148.59 / $3,426.70 / $7,099.73
| Facility | | $2,148.59 | $3,426.70 | $7,099.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,454.10 / $2,044.42 / $4,797.00
| Facility | | $1,454.10 | $2,044.42 | $4,797.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,735.00 / $4,974.00 / $8,812.00
| Facility | | $2,735.00 | $4,974.00 | $8,812.00 |