- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,023.70 / $1,023.70 / $1,023.70
| Facility | | $1,023.70 | $1,023.70 | $1,023.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,219.37 / $11,589.55 / $24,582.80
| Facility | | $5,219.37 | $11,589.55 | $24,582.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,531.85 / $3,590.47 / $8,637.37
| Facility | | $2,531.85 | $3,590.47 | $8,637.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,058.21 / $3,282.55 / $6,801.08
| Facility | | $2,058.21 | $3,282.55 | $6,801.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,333.04 / $1,815.73 / $3,378.00
| Facility | | $1,333.04 | $1,815.73 | $3,378.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,751.00 / $3,500.00 / $8,152.00
| Facility | | $1,751.00 | $3,500.00 | $8,152.00 |