- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,642.09 / $2,642.09 / $2,642.09
| Facility | | $2,642.09 | $2,642.09 | $2,642.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,994.80 / $11,084.74 / $21,726.70
| Facility | | $4,994.80 | $11,084.74 | $21,726.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,132.52 / $8,696.68 / $20,921.04
| Facility | | $6,132.52 | $8,696.68 | $20,921.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,985.30 / $7,950.85 / $16,473.25
| Facility | | $4,985.30 | $7,950.85 | $16,473.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,478.56 / $4,273.07 / $5,868.74
| Facility | | $2,478.56 | $4,273.07 | $5,868.74 |
- 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 |