- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,405.43 / $3,405.43 / $3,405.43
| Facility | | $3,405.43 | $3,405.43 | $3,405.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,535.95 / $14,052.30 / $27,782.05
| Facility | | $6,535.95 | $14,052.30 | $27,782.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,523.10 / $10,668.69 / $25,664.99
| Facility | | $7,523.10 | $10,668.69 | $25,664.99 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,115.74 / $9,753.74 / $20,208.65
| Facility | | $6,115.74 | $9,753.74 | $20,208.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,053.00 / $5,385.78 / $8,472.73
| Facility | | $3,053.00 | $5,385.78 | $8,472.73 |
- 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 |