- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,811.14 / $4,811.14 / $4,811.14
| Facility | | $4,811.14 | $4,811.14 | $4,811.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,615.25 / $22,788.54 / $44,711.81
| Facility | | $10,615.25 | $22,788.54 | $44,711.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,228.48 / $17,524.75 / $42,158.16
| Facility | | $11,228.48 | $17,524.75 | $42,158.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,730.46 / $15,992.48 / $33,195.40
| Facility | | $9,730.46 | $15,992.48 | $33,195.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,613.95 / $8,130.83 / $14,810.18
| Facility | | $4,613.95 | $8,130.83 | $14,810.18 |
- 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 |