- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,713.37 / $2,713.37 / $2,713.37
| Facility | | $2,713.37 | $2,713.37 | $2,713.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,430.52 / $11,675.62 / $23,185.49
| Facility | | $5,430.52 | $11,675.62 | $23,185.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,278.24 / $8,903.32 / $21,418.14
| Facility | | $6,278.24 | $8,903.32 | $21,418.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,103.75 / $8,139.77 / $16,864.68
| Facility | | $5,103.75 | $8,139.77 | $16,864.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,951.64 / $4,476.93 / $6,539.46
| Facility | | $1,951.64 | $4,476.93 | $6,539.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,751.00 / $3,500.00 / $8,152.00
| Facility | | $1,751.00 | $3,500.00 | $8,152.00 |