- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,046.68 / $3,046.68 / $3,046.68
| Facility | | $3,046.68 | $3,046.68 | $3,046.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,466.88 / $17,077.12 / $28,512.00
| Facility | | $7,466.88 | $17,077.12 | $28,512.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,073.67 / $11,040.16 / $26,558.61
| Facility | | $7,073.67 | $11,040.16 | $26,558.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,129.96 / $10,074.87 / $20,912.29
| Facility | | $6,129.96 | $10,074.87 | $20,912.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,043.00 / $5,125.33 / $9,494.66
| Facility | | $3,043.00 | $5,125.33 | $9,494.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $796.00 / $3,500.00 / $8,152.00
| Facility | | $796.00 | $3,500.00 | $8,152.00 |