- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,879.75 / $2,879.75 / $2,879.75
| Facility | | $2,879.75 | $2,879.75 | $2,879.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,466.88 / $16,680.68 / $27,323.88
| Facility | | $7,466.88 | $16,680.68 | $27,323.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,693.31 / $10,446.53 / $25,130.54
| Facility | | $6,693.31 | $10,446.53 | $25,130.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,800.35 / $9,533.14 / $19,787.83
| Facility | | $5,800.35 | $9,533.14 | $19,787.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,446.98 / $4,688.06 / $8,947.33
| Facility | | $2,446.98 | $4,688.06 | $8,947.33 |
- 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 |