- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,019.82 / $2,019.82 / $2,019.82
| Facility | | $2,019.82 | $2,019.82 | $2,019.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,872.29 / $8,325.41 / $16,548.80
| Facility | | $3,872.29 | $8,325.41 | $16,548.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,480.84 / $6,354.39 / $15,286.36
| Facility | | $4,480.84 | $6,354.39 | $15,286.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,642.60 / $5,809.44 / $12,036.50
| Facility | | $3,642.60 | $5,809.44 | $12,036.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,617.66 / $3,378.00 / $5,004.29
| Facility | | $1,617.66 | $3,378.00 | $5,004.29 |
- 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 |