- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,288.59 / $1,288.59 / $1,288.59
| Facility | | $1,288.59 | $1,288.59 | $1,288.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,501.83 / $10,415.11 / $20,316.56
| Facility | | $5,501.83 | $10,415.11 | $20,316.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,846.01 / $4,036.00 / $9,709.12
| Facility | | $2,846.01 | $4,036.00 | $9,709.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,313.60 / $3,689.87 / $7,644.99
| Facility | | $2,313.60 | $3,689.87 | $7,644.99 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,802.26 / $2,349.94 / $3,500.00
| Facility | | $1,802.26 | $2,349.94 | $3,500.00 |
- 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 |