- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,273.73 / $2,273.73 / $2,273.73
| Facility | | $2,273.73 | $2,273.73 | $2,273.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,425.97 / $3,144.69 / $19,298.22
| Facility | | $1,425.97 | $3,144.69 | $19,298.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,303.53 / $8,277.43 / $19,912.49
| Facility | | $5,303.53 | $8,277.43 | $19,912.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,595.97 / $7,553.70 / $15,679.13
| Facility | | $4,595.97 | $7,553.70 | $15,679.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,027.68 / $3,709.07 / $7,080.74
| Facility | | $2,027.68 | $3,709.07 | $7,080.74 |
- 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 |