- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,303.15 / $1,303.15 / $1,303.15
| Facility | | $1,303.15 | $1,303.15 | $1,303.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,045.81 / $7,713.74 / $12,643.17
| Facility | | $4,045.81 | $7,713.74 | $12,643.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,473.50 / $4,925.85 / $11,849.80
| Facility | | $3,473.50 | $4,925.85 | $11,849.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,823.70 / $4,503.41 / $9,330.54
| Facility | | $2,823.70 | $4,503.41 | $9,330.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,661.31 / $2,666.60 / $11,496.00
| Facility | | $1,661.31 | $2,666.60 | $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 |