- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,112.73 / $3,112.73 / $3,112.73
| Facility | | $3,112.73 | $3,112.73 | $3,112.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,933.95 / $12,757.99 / $25,605.59
| Facility | | $5,933.95 | $12,757.99 | $25,605.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,872.03 / $9,745.40 / $23,443.87
| Facility | | $6,872.03 | $9,745.40 | $23,443.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,586.47 / $8,909.62 / $18,459.74
| Facility | | $5,586.47 | $8,909.62 | $18,459.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,191.57 / $4,903.45 / $7,717.81
| Facility | | $2,191.57 | $4,903.45 | $7,717.81 |
- 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 |