- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,028.54 / $1,028.54 / $1,028.54
| Facility | | $1,028.54 | $1,028.54 | $1,028.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,272.27 / $14,288.40 / $27,674.38
| Facility | | $5,272.27 | $14,288.40 | $27,674.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,541.48 / $3,606.00 / $8,674.71
| Facility | | $2,541.48 | $3,606.00 | $8,674.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,310.44 / $3,296.75 / $6,830.49
| Facility | | $2,310.44 | $3,296.75 | $6,830.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,028.54 / $1,878.74 / $5,100.00
| Facility | | $1,028.54 | $1,878.74 | $5,100.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,457.00 / $9,370.00 / $12,774.00
| Facility | | $5,457.00 | $9,370.00 | $12,774.00 |