- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $151.36 / $151.36 / $151.36
| Facility | | $151.36 | $151.36 | $151.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,187.76 / $10,964.78 / $19,952.62
| Facility | | $2,187.76 | $10,964.78 | $19,952.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,019.95 / $7,585.78 / $7,585.78
| Facility | | $3,019.95 | $7,585.78 | $7,585.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,754.23 / $10,964.78 / $18,620.87
| Facility | | $2,754.23 | $10,964.78 | $18,620.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,047.13 / $18,197.01 / $40,738.03
| Facility | | $1,047.13 | $18,197.01 | $40,738.03 |