- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,773.13 / $2,773.13 / $2,773.13
| Facility | | $2,773.13 | $2,773.13 | $2,773.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,316.17 / $11,429.77 / $22,859.38
| Facility | | $5,316.17 | $11,429.77 | $22,859.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,138.42 / $8,705.04 / $20,941.16
| Facility | | $6,138.42 | $8,705.04 | $20,941.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,990.09 / $7,958.50 / $16,489.09
| Facility | | $4,990.09 | $7,958.50 | $16,489.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,379.08 / $4,385.24 / $6,885.94
| Facility | | $2,379.08 | $4,385.24 | $6,885.94 |
- 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 |