- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,084.77 / $2,084.77 / $2,084.77
| Facility | | $2,084.77 | $2,084.77 | $2,084.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,816.74 / $9,547.15 / $18,399.64
| Facility | | $1,816.74 | $9,547.15 | $18,399.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,838.99 / $7,552.41 / $18,168.34
| Facility | | $4,838.99 | $7,552.41 | $18,168.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,193.41 / $6,892.07 / $14,305.79
| Facility | | $4,193.41 | $6,892.07 | $14,305.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,084.77 / $3,523.26 / $6,358.40
| Facility | | $2,084.77 | $3,523.26 | $6,358.40 |
- 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 |