- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,946.34 / $2,946.34 / $2,946.34
| Facility | | $2,946.34 | $2,946.34 | $2,946.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,184.29 / $10,622.61 / $23,041.04
| Facility | | $4,184.29 | $10,622.61 | $23,041.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,235.89 / $10,261.39 / $24,685.16
| Facility | | $7,235.89 | $10,261.39 | $24,685.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,882.26 / $9,381.37 / $19,437.14
| Facility | | $5,882.26 | $9,381.37 | $19,437.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,455.00 / $4,979.31 / $7,358.40
| Facility | | $3,455.00 | $4,979.31 | $7,358.40 |
- 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 |