- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,072.16 / $1,072.16 / $1,072.16
| Facility | | $1,072.16 | $1,072.16 | $1,072.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,045.81 / $6,880.21 / $12,643.17
| Facility | | $4,045.81 | $6,880.21 | $12,643.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,862.01 / $4,058.69 / $9,763.73
| Facility | | $2,862.01 | $4,058.69 | $9,763.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,326.61 / $3,710.62 / $7,687.98
| Facility | | $2,326.61 | $3,710.62 | $7,687.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,411.11 / $2,275.79 / $11,496.00
| Facility | | $1,411.11 | $2,275.79 | $11,496.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,028.00 / $11,496.00 / $21,528.00
| Facility | | $5,028.00 | $11,496.00 | $21,528.00 |