- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,306.75 / $1,306.75 / $1,306.75
| Facility | | $1,306.75 | $1,306.75 | $1,306.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,530.69 / $10,586.97 / $21,031.38
| Facility | | $5,530.69 | $10,586.97 | $21,031.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,194.71 / $4,530.49 / $10,898.71
| Facility | | $3,194.71 | $4,530.49 | $10,898.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,597.07 / $4,141.96 / $8,581.66
| Facility | | $2,597.07 | $4,141.96 | $8,581.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,732.08 / $2,274.44 / $3,934.18
| Facility | | $1,732.08 | $2,274.44 | $3,934.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,296.00 / $3,500.00 / $6,361.00
| Facility | | $2,296.00 | $3,500.00 | $6,361.00 |