- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,767.85 / $2,767.85 / $2,767.85
| Facility | | $2,767.85 | $2,767.85 | $2,767.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,466.88 / $15,929.94 / $26,541.78
| Facility | | $7,466.88 | $15,929.94 | $26,541.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,435.41 / $10,044.00 / $24,162.21
| Facility | | $6,435.41 | $10,044.00 | $24,162.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,576.85 / $9,165.81 / $19,025.36
| Facility | | $5,576.85 | $9,165.81 | $19,025.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,842.18 / $4,677.67 / $8,595.29
| Facility | | $2,842.18 | $4,677.67 | $8,595.29 |
- 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 |