- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,860.80 / $2,860.80 / $2,860.80
| Facility | | $2,860.80 | $2,860.80 | $2,860.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,425.97 / $3,144.69 / $24,398.06
| Facility | | $1,425.97 | $3,144.69 | $24,398.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,657.34 / $10,390.39 / $24,995.49
| Facility | | $6,657.34 | $10,390.39 | $24,995.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,769.18 / $9,481.91 / $19,681.49
| Facility | | $5,769.18 | $9,481.91 | $19,681.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,828.69 / $4,834.75 / $8,859.12
| Facility | | $2,828.69 | $4,834.75 | $8,859.12 |
- 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 |