- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,938.28 / $2,938.28 / $2,938.28
| Facility | | $2,938.28 | $2,938.28 | $2,938.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,466.88 / $16,779.56 / $27,519.35
| Facility | | $7,466.88 | $16,779.56 | $27,519.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,823.41 / $10,649.58 / $25,619.01
| Facility | | $6,823.41 | $10,649.58 | $25,619.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,913.09 / $9,718.44 / $20,172.45
| Facility | | $5,913.09 | $9,718.44 | $20,172.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,938.28 / $4,934.01 / $9,139.26
| Facility | | $2,938.28 | $4,934.01 | $9,139.26 |
- 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 |