- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,863.23 / $1,863.23 / $1,863.23
| Facility | | $1,863.23 | $1,863.23 | $1,863.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,562.08 / $7,658.47 / $15,295.85
| Facility | | $3,562.08 | $7,658.47 | $15,295.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,123.72 / $5,847.95 / $14,068.04
| Facility | | $4,123.72 | $5,847.95 | $14,068.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,352.29 / $5,346.43 / $11,077.20
| Facility | | $3,352.29 | $5,346.43 | $11,077.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,473.50 / $3,426.93 / $5,100.54
| Facility | | $2,473.50 | $3,426.93 | $5,100.54 |
- 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 |