- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,238.72 / $2,238.72 / $2,238.72
| Facility | | $2,238.72 | $2,238.72 | $2,238.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,585.78 / $14,791.08 / $42,657.95
| Facility | | $7,585.78 | $14,791.08 | $42,657.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,370.32 / $8,709.64 / $20,417.38
| Facility | | $5,370.32 | $8,709.64 | $20,417.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,606.93 / $8,317.64 / $16,218.10
| Facility | | $6,606.93 | $8,317.64 | $16,218.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,187.76 / $3,388.44 / $6,760.83
| Facility | | $2,187.76 | $3,388.44 | $6,760.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $794.33 / $3,311.31 / $8,511.38
| Facility | | $794.33 | $3,311.31 | $8,511.38 |