- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,687.78 / $2,687.78 / $2,687.78
| Facility | | $2,687.78 | $2,687.78 | $2,687.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,466.88 / $15,889.28 / $25,900.16
| Facility | | $7,466.88 | $15,889.28 | $25,900.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,232.60 / $9,727.48 / $23,400.77
| Facility | | $6,232.60 | $9,727.48 | $23,400.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,401.10 / $8,876.95 / $18,425.80
| Facility | | $5,401.10 | $8,876.95 | $18,425.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,611.55 / $4,379.17 / $8,356.95
| Facility | | $2,611.55 | $4,379.17 | $8,356.95 |
- 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 |