- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,148.38 / $3,148.38 / $3,148.38
| Facility | | $3,148.38 | $3,148.38 | $3,148.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,335.50 / $13,621.33 / $27,276.20
| Facility | | $6,335.50 | $13,621.33 | $27,276.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,302.43 / $10,355.75 / $24,912.16
| Facility | | $7,302.43 | $10,355.75 | $24,912.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,936.35 / $9,467.64 / $19,615.88
| Facility | | $5,936.35 | $9,467.64 | $19,615.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,401.06 / $5,219.39 / $6,771.10
| Facility | | $3,401.06 | $5,219.39 | $6,771.10 |
- 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 |