- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,019.21 / $1,019.21 / $1,019.21
| Facility | | $1,019.21 | $1,019.21 | $1,019.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,725.64 / $9,560.76 / $20,316.56
| Facility | | $4,725.64 | $9,560.76 | $20,316.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,271.59 / $3,221.39 / $7,749.49
| Facility | | $2,271.59 | $3,221.39 | $7,749.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,846.64 / $2,945.12 / $6,101.96
| Facility | | $1,846.64 | $2,945.12 | $6,101.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,474.88 / $2,085.46 / $12,367.00
| Facility | | $1,474.88 | $2,085.46 | $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 |