- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,710.06 / $2,710.06 / $2,710.06
| Facility | | $2,710.06 | $2,710.06 | $2,710.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,509.28 / $6,665.78 / $22,151.85
| Facility | | $2,509.28 | $6,665.78 | $22,151.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,630.30 / $9,402.59 / $22,619.21
| Facility | | $6,630.30 | $9,402.59 | $22,619.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,389.96 / $8,596.21 / $17,810.40
| Facility | | $5,389.96 | $8,596.21 | $17,810.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,455.00 / $4,580.00 / $7,085.11
| Facility | | $3,455.00 | $4,580.00 | $7,085.11 |
- 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 |