- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,494.25 / $2,494.25 / $2,494.25
| Facility | | $2,494.25 | $2,494.25 | $2,494.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,781.21 / $10,279.60 / $20,473.59
| Facility | | $4,781.21 | $10,279.60 | $20,473.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,522.73 / $7,831.91 / $18,840.72
| Facility | | $5,522.73 | $7,831.91 | $18,840.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,489.58 / $7,160.24 / $14,835.21
| Facility | | $4,489.58 | $7,160.24 | $14,835.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,821.84 / $3,943.11 / $6,187.14
| Facility | | $1,821.84 | $3,943.11 | $6,187.14 |
- 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 |