- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,154.72 / $3,154.72 / $3,154.72
| Facility | | $3,154.72 | $3,154.72 | $3,154.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,058.16 / $13,025.04 / $26,140.53
| Facility | | $6,058.16 | $13,025.04 | $26,140.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,974.79 / $9,891.12 / $23,794.42
| Facility | | $6,974.79 | $9,891.12 | $23,794.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,670.00 / $9,042.85 / $18,735.75
| Facility | | $5,670.00 | $9,042.85 | $18,735.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,455.00 / $4,992.77 / $7,953.14
| Facility | | $3,455.00 | $4,992.77 | $7,953.14 |
- 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 |