- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,115.10 / $1,115.10 / $1,115.10
| Facility | | $1,115.10 | $1,115.10 | $1,115.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,045.81 / $6,972.83 / $12,643.17
| Facility | | $4,045.81 | $6,972.83 | $12,643.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,988.35 / $4,237.85 / $10,194.73
| Facility | | $2,988.35 | $4,237.85 | $10,194.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,429.32 / $3,874.42 / $8,027.35
| Facility | | $2,429.32 | $3,874.42 | $8,027.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,414.75 / $2,289.73 / $11,496.00
| Facility | | $1,414.75 | $2,289.73 | $11,496.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,028.00 / $11,069.43 / $21,442.00
| Facility | | $5,028.00 | $11,069.43 | $21,442.00 |