- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,781.96 / $2,781.96 / $2,781.96
| Facility | | $2,781.96 | $2,781.96 | $2,781.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,466.88 / $16,004.13 / $26,665.39
| Facility | | $7,466.88 | $16,004.13 | $26,665.39 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,475.20 / $10,106.11 / $24,311.63
| Facility | | $6,475.20 | $10,106.11 | $24,311.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,611.34 / $9,222.49 / $19,143.00
| Facility | | $5,611.34 | $9,222.49 | $19,143.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,853.48 / $4,701.51 / $8,657.79
| Facility | | $2,853.48 | $4,701.51 | $8,657.79 |
- 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 |