- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,022.96 / $1,022.96 / $1,022.96
| Facility | | $1,022.96 | $1,022.96 | $1,022.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,298.96 / $16,192.78 / $36,581.76
| Facility | | $2,298.96 | $16,192.78 | $36,581.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,389.27 / $3,729.03 / $8,970.68
| Facility | | $2,389.27 | $3,729.03 | $8,970.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,070.51 / $3,402.98 / $7,063.53
| Facility | | $2,070.51 | $3,402.98 | $7,063.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,086.54 / $1,875.22 / $3,258.59
| Facility | | $1,086.54 | $1,875.22 | $3,258.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $796.00 / $2,260.00 / $5,379.86
| Facility | | $796.00 | $2,260.00 | $5,379.86 |