- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,054.84 / $1,054.84 / $1,054.84
| Facility | | $1,054.84 | $1,054.84 | $1,054.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,184.29 / $6,899.45 / $13,020.23
| Facility | | $4,184.29 | $6,899.45 | $13,020.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,607.65 / $3,697.97 / $8,895.96
| Facility | | $2,607.65 | $3,697.97 | $8,895.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,119.83 / $3,380.83 / $7,004.70
| Facility | | $2,119.83 | $3,380.83 | $7,004.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,366.58 / $1,874.93 / $3,455.00
| Facility | | $1,366.58 | $1,874.93 | $3,455.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,751.00 / $3,500.00 / $8,152.00
| Facility | | $1,751.00 | $3,500.00 | $8,152.00 |