- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,012.95 / $1,012.95 / $1,012.95
| Facility | | $1,012.95 | $1,012.95 | $1,012.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,090.33 / $9,984.76 / $20,811.61
| Facility | | $4,090.33 | $9,984.76 | $20,811.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,349.07 / $3,331.28 / $8,013.84
| Facility | | $2,349.07 | $3,331.28 | $8,013.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,909.63 / $3,045.59 / $6,310.11
| Facility | | $1,909.63 | $3,045.59 | $6,310.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $915.52 / $1,669.37 / $7,770.00
| Facility | | $915.52 | $1,669.37 | $7,770.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,740.00 / $4,289.00 / $8,193.00
| Facility | | $2,740.00 | $4,289.00 | $8,193.00 |