- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,392.64 / $3,392.64 / $3,392.64
| Facility | | $3,392.64 | $3,392.64 | $3,392.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,184.29 / $11,070.22 / $28,520.84
| Facility | | $4,184.29 | $11,070.22 | $28,520.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,328.31 / $11,810.57 / $28,411.93
| Facility | | $8,328.31 | $11,810.57 | $28,411.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,770.31 / $10,797.70 / $22,371.60
| Facility | | $6,770.31 | $10,797.70 | $22,371.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,455.00 / $5,733.56 / $8,894.37
| Facility | | $3,455.00 | $5,733.56 | $8,894.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,751.00 / $3,500.00 / $8,152.00
| Facility | | $1,751.00 | $3,500.00 | $8,152.00 |