- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,372.72 / $3,372.72 / $3,372.72
| Facility | | $3,372.72 | $3,372.72 | $3,372.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,466.94 / $13,903.93 / $27,845.47
| Facility | | $6,466.94 | $13,903.93 | $27,845.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,459.09 / $10,577.92 / $25,446.61
| Facility | | $7,459.09 | $10,577.92 | $25,446.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,063.70 / $9,670.75 / $20,036.70
| Facility | | $6,063.70 | $9,670.75 | $20,036.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,069.91 / $5,335.02 / $8,266.27
| Facility | | $3,069.91 | $5,335.02 | $8,266.27 |
- 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 |