- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,206.40 / $1,206.40 / $1,206.40
| Facility | | $1,206.40 | $1,206.40 | $1,206.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,173.08 / $2,992.74 / $10,073.02
| Facility | | $1,173.08 | $2,992.74 | $10,073.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,814.77 / $4,393.13 / $10,568.27
| Facility | | $2,814.77 | $4,393.13 | $10,568.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,439.25 / $4,009.02 / $8,321.48
| Facility | | $2,439.25 | $4,009.02 | $8,321.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,204.29 / $2,082.48 / $3,763.71
| Facility | | $1,204.29 | $2,082.48 | $3,763.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $796.00 / $3,500.00 / $8,152.00
| Facility | | $796.00 | $3,500.00 | $8,152.00 |