- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,010.80 / $1,010.80 / $1,010.80
| Facility | | $1,010.80 | $1,010.80 | $1,010.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,847.56 / $10,083.07 / $20,316.56
| Facility | | $3,847.56 | $10,083.07 | $20,316.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,239.58 / $3,176.00 / $7,640.30
| Facility | | $2,239.58 | $3,176.00 | $7,640.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,820.62 / $2,903.63 / $6,015.99
| Facility | | $1,820.62 | $2,903.63 | $6,015.99 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,432.42 / $2,063.27 / $12,367.00
| Facility | | $1,432.42 | $2,063.27 | $12,367.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,577.00 / $10,743.00 / $12,774.00
| Facility | | $5,577.00 | $10,743.00 | $12,774.00 |