- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,228.11 / $1,228.11 / $1,228.11
| Facility | | $1,228.11 | $1,228.11 | $1,228.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,926.68 / $31,774.48 / $66,228.75
| Facility | | $5,926.68 | $31,774.48 | $66,228.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,980.92 / $4,229.49 / $10,174.62
| Facility | | $2,980.92 | $4,229.49 | $10,174.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,709.93 / $3,866.77 / $8,011.51
| Facility | | $2,709.93 | $3,866.77 | $8,011.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,276.48 / $2,094.92 / $3,612.82
| Facility | | $1,276.48 | $2,094.92 | $3,612.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,028.00 / $11,496.00 / $21,528.00
| Facility | | $5,028.00 | $11,496.00 | $21,528.00 |