- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,736.78 / $2,736.78 / $2,736.78
| Facility | | $2,736.78 | $2,736.78 | $2,736.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,466.88 / $15,918.30 / $26,353.41
| Facility | | $7,466.88 | $15,918.30 | $26,353.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,366.53 / $9,936.50 / $23,903.61
| Facility | | $6,366.53 | $9,936.50 | $23,903.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,517.16 / $9,067.70 / $18,821.74
| Facility | | $5,517.16 | $9,067.70 | $18,821.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,736.78 / $4,625.16 / $8,527.17
| Facility | | $2,736.78 | $4,625.16 | $8,527.17 |
- 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 |