- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,539.62 / $2,539.62 / $2,539.62
| Facility | | $2,539.62 | $2,539.62 | $2,539.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,466.88 / $15,632.27 / $24,824.33
| Facility | | $7,466.88 | $15,632.27 | $24,824.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,907.35 / $9,219.84 / $22,179.58
| Facility | | $5,907.35 | $9,219.84 | $22,179.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,119.24 / $8,413.70 / $17,464.24
| Facility | | $5,119.24 | $8,413.70 | $17,464.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,595.60 / $4,629.08 / $7,985.96
| Facility | | $2,595.60 | $4,629.08 | $7,985.96 |
- 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 |