- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,026.71 / $1,026.71 / $1,026.71
| Facility | | $1,026.71 | $1,026.71 | $1,026.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,257.84 / $9,876.74 / $21,331.89
| Facility | | $5,257.84 | $9,876.74 | $21,331.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,392.33 / $3,733.80 / $8,982.17
| Facility | | $2,392.33 | $3,733.80 | $8,982.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,073.16 / $3,407.34 / $7,072.58
| Facility | | $2,073.16 | $3,407.34 | $7,072.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,077.30 / $1,827.05 / $3,248.10
| Facility | | $1,077.30 | $1,827.05 | $3,248.10 |
- 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 |