- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,021.14 / $2,021.14 / $2,021.14
| Facility | | $2,021.14 | $2,021.14 | $2,021.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,425.97 / $2,992.74 / $17,057.18
| Facility | | $1,425.97 | $2,992.74 | $17,057.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,706.60 / $7,345.78 / $17,671.25
| Facility | | $4,706.60 | $7,345.78 | $17,671.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,078.68 / $6,703.50 / $13,914.38
| Facility | | $4,078.68 | $6,703.50 | $13,914.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,088.58 / $3,415.73 / $6,321.95
| Facility | | $2,088.58 | $3,415.73 | $6,321.95 |
- 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 |