- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,748.82 / $2,748.82 / $2,748.82
| Facility | | $2,748.82 | $2,748.82 | $2,748.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,272.79 / $11,336.51 / $22,610.49
| Facility | | $5,272.79 | $11,336.51 | $22,610.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,089.57 / $8,635.77 / $20,774.50
| Facility | | $6,089.57 | $8,635.77 | $20,774.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,950.38 / $7,895.16 / $16,357.88
| Facility | | $4,950.38 | $7,895.16 | $16,357.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,279.53 / $4,346.75 / $6,823.26
| Facility | | $2,279.53 | $4,346.75 | $6,823.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,445.00 / $3,236.00 / $5,530.00
| Facility | | $1,445.00 | $3,236.00 | $5,530.00 |