- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,813.30 / $1,813.30 / $1,813.30
| Facility | | $1,813.30 | $1,813.30 | $1,813.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,425.97 / $2,992.74 / $15,271.08
| Facility | | $1,425.97 | $2,992.74 | $15,271.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,219.85 / $6,586.11 / $15,843.79
| Facility | | $4,219.85 | $6,586.11 | $15,843.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,656.88 / $6,010.26 / $12,475.43
| Facility | | $3,656.88 | $6,010.26 | $12,475.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,763.27 / $3,064.48 / $5,657.70
| Facility | | $1,763.27 | $3,064.48 | $5,657.70 |
- 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 |