- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,626.46 / $2,626.46 / $2,626.46
| Facility | | $2,626.46 | $2,626.46 | $2,626.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,425.97 / $3,144.69 / $22,358.64
| Facility | | $1,425.97 | $3,144.69 | $22,358.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,102.50 / $9,524.42 / $22,912.29
| Facility | | $6,102.50 | $9,524.42 | $22,912.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,288.36 / $8,691.66 / $18,041.18
| Facility | | $5,288.36 | $8,691.66 | $18,041.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,626.46 / $4,438.72 / $8,161.44
| Facility | | $2,626.46 | $4,438.72 | $8,161.44 |
- 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 |